Successful Angioplasty of Radiation-induced Iliofemoral Artery Stenosis: a Case Report

Abstract

Introduction saphenous vein graft 6 months later, with a good result. Arterial injury secondary to radiotherapy is uncommon but well documented in the medical literature. It is generally accepted that surgery is the primary mode of treatment and there are very few documented cases of successful balloon angioplasty Discussion of the iliofemoral vessels in the medical literature. We report this case with the longest documented interval The age of patients presenting with radiation induced of 25 years between exposure to radiation and preiliofemoral lesions ranges from 50 to 56 years and sentation. these lesions cannot be histologically or biochemically distinguished from normal atherosclerosis. It is quite probable that the incidence is underestimated because when such patients present symptoms may be attributed to atherosclerotic disease rather than raCase History diation. Our patient was only 26 years old with no family history of early onset atherosclerotic disease A 26-year-old man presented with a 6 month history of left sided calf claudication and no palpable pulses and his lesion was focal. He smokes approximately 10 cigarettes per day, and hypertension, cigarette smoking in that limb. He had previous pelvic radiotherapy at age 16 months for an embryonic bladder sarcoma and and hyperlipidaemia act synergistically with radiation. It was also interesting that the accompanying veins had a subsequent cystectomy. An angiogram revealed marked attenuation of the left external iliac with ocdid not show any damage and veins are known to be more radioresistant than arteries. clusion of the distal end of this vessel that extended down to the level of the origin of the profunda femoris. Radiation delays wound healing and causes perivascular fibrosis which makes surgery more difficult. Collateral vessels reconstituted the superficial femoral artery and on the right side all the vessels appeared In our case our patient responded well to the initial angioplasty but returned with stenosis of the proximal normal. He underwent a successful open balloon angioplasty superficial femoral artery, which was most likely a fibrotic reaction to the patch. This was treated with a of the left external iliac and femoral arteries and the femoral artery was closed with a dacron patch. Eight reverse saphenous vein femoral-popliteal bypass with good result. months after the balloon angioplasty, he presented with left calf claudication. An angiogram confirmed Angioplasty in our case avoided an aorto-bifemoral bypass, which has a significantly higher morbidity. It patency of the previously angioplastied segment but revealed stenosis of the proximal superficial femoral was quite unexpected for the patient to respond so well to angioplasty 25 years after the initial insult. We artery. He had a dacron patch angioplasty and surgical endarterectomy but his symptoms did not improve believe that in cases like this, angioplasty should be considered as the primary mode of treatment. and had a left femoral-popliteal bypass using a reverse