Treatment of Radiation Induced Arterial Occlusion: Importance of Extraanatomic Approach: Case Reports

Abstract

Radiation injury is an uncommon but increasingly important cause of arterial insufficiency. Radiation-induced vascular compromise can threaten limbs once thought salvaged by radiotherapy in the course of treating neoplasms. Two cases of latent arterial occlusion secondary to radiotherapy are reported. The alteration of tissue architecture surrounding this type of arterial injury requires a different approach to vascular repair afforded only by extraanatomic bypass grafting.

The perspective of liver transplantation for cholangiocarcinoma

“…This change of policy appears worthwhile in the light of former results emphasizing the importance of extra-anatomic approaches in the treatment of radiation-induced arterial occlusions. 21 Indeed, the authors did not find any difference in early or late arterial complications between the study group and a matched patient population that had undergone DDLT using an arterial interposition graft to the infrarenal aorta but for an indication different from cholangiocarcinoma. On the other hand, the risk of arterial complications was 11% in the DDLT study group with an arterial interposition graft versus 15% in the matched group.…”

Innominate to contralateral brachial artery bypass via ministernotomy with anatomic tunneling for critical ischemia of the left upper extremity

“…Such prior radiation adds to the hostility of the operative field and potentially increases the risk of infection. 1 The pathogenesis of irradiation-induced occlusive disease in large arteries, such as the subclavian and axillary arteries, involves three processes: (1) endothelial injury and disruption of the internal elastic lamina, (2) followed by intimal fibrosis and plaque formation, and (3) occlusion of the vasa vasora which results in both fibrosis of the media and constrictive periarterial fibrosis which results in extrinsic constriction of the artery. Fibrotic occlusion of the irradiated artery is a more delayed process, usually up to 10 years later.…”

“…External beam radiation therapy causes an obliterative intravascular response in addition to fibrotic perivascular tissue changes, resulting in fibrotic and noncompliant tissue planes. 1,2 This poses a high risk of surgical wound complications including wound breakdown, lymphatic leaks, poor healing, and infections are well described and the risk is particularly higher with prosthetic conduits. The use of non-autogenous conduit further increases the risk of infection and other wound-related complications.…”

“…Extra-anatomic bypass, where feasible, is usually the preferred option due to a lower risk of vascular injury and infection. 1,3–11 Radiation-induced vasculopathy involving the subclavian, axillary, and brachial arteries following multi-modality treatment of breast cancer has been described. 2,4,7,9 Radiation is also a known risk factor for progressive atherosclerotic occlusive vascular disease.…”

Surgical Correction of Innominate and Brachiocephalic Vein Occlusion from Radiation Therapy and Multiple Indwelling Portacatheters A Case Report

“…(1) There is no progressive AVF that requires future ligation owing to the nonexpansive nature of polytetrafluoroethylene. (2) Arterial flow into the PTFE graft is limited by the ostium created for the AVF (Poiseuille's law). (3) The Venturi effect of arterial flow via the fistula into the PTFE graft facilitates venous flow into the graft.…”