Radiation-related arterial disease

Arterial occlusive disease has been recognized in association with radiatio n arteriopathy and, rarely, with spontaneous arterial disruption. This asso ciation results from the greater role of radiation therapy in the current m anagement of malignant diseases coupled with longer patient survival and th e lengthy latency period between radiation and clinical manifestations of r adiation arteriopathy. Experience with six patients having radiation-associ ated arterial disease was retrospectively reviewed. There were four men and two women, with a mean age of 51 years (range, 36-74). Arteries exposed to radiation include two carotids, three subclavians, one coronary, and one f emoral. The time from radiation therapy until clinical arterial disease was a mean of 14.3 years (range, 4-30). Operative repairs with polytetrafluoro ethylene and saphenous vein bypass grafts were performed in four patients, stent placement in one patient, and one patient had spontaneous carotid dis ruption that ultimately was treat-ed with ligation. In conclusion, elective bypass can be performed safely and successfully for aterial occlusive dise ase in a previously irradiated artery. In contrast, life-threatening arteri al disruption secondary to radiation arteriopathy usually requires concomit ant exposure to a source of bacterial contamination, and ligation may be th e best choice to prevent recurrent hemorrhage.