Radiation-induced aorto-ilio-femoral arterial occlusion.

Objectives : To assess long-term outcome after surgical cure of radiation-i nduced aorto-ilio-femoral arterial occlusion and to deduce therapeutic indi cations. Patients and methods : Over a 20-year period, 15 patients were treated for occlusion of the aorto-ilio-femoral vessels 4 to 28 years after receiving r adiotherapy Primary treatment was medical (n = 1), balloon dilatation (n = 5), anatomic revascularization (n = 5), and extra-anatomic bypass (n = 4). Mean follow-up was 6.8 years. Results : Among the 5 balloon dilatations, there was one failure requiring right axillofemoral bypass that was followed shortly by fatal septic shock; the 4 others have remained patent at 2 to 15 years, one having required st ent dilatation at 6 months. Among the 5 patients who had anatomic revascula rization, excepting on patient who died shortly after surgery from her canc er, all have required revision; 2 patients died of infection at 9 and 10 ye ars; the two others are alive at 5 and 18 years. Among the 4 patients with extra-anatomic bypass (one aortothoracic-bifemoral bypass, two axillofemora l bypasses and one cross-over bypass), 2 died with prosthetic sepsis at 3 a nd 7 years and 2 others have had a bypass replacement. Overall, at last fol low-up, half of the operated patients have died from infection (n = 5) or c ancer (n = 2). Discussion : In reports in the literature, revision and infection after con ventional surgery is frequent. There is less risk with the endovascular app roach, but it can be only applied for short occlusions. Conclusion : Excepting easily accessible occlusions with an apparent minima l risk for percutaneous balloon dilatation, irradiated arteries should be o perated on only in case of severe ischemia. Patients with claudication shou ld be treated conservatively because of the hight risk of complications for prosthesis implantation with irradiated arteries.