[Radiation-induced aorto-ilio-femoral arterial arteritis. Mediocrity of the long-term results after conventional surgery].
OBJECTIVE
To assess long-term outcome after surgical cure of radiation-induced aorto-ilio-femoral arterial occlusion and to deduce therapeutic indications.


METHODS
Over a 20-year period, 15 patients were treated for occlusion of the aorto-ilio-femoral vessels 4 to 28 years after receiving radiotherapy. 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 stent dilatation at 6 months. Among the 5 patients who had anatomic revascularization, excepting on patient who died shortly after surgery from her cancer, all have required revision; 2 patients died of infection at 9 and 10 years; the two others are alive at 5 and 18 years. Among the 4 patients with extra-anatomic bypass (one aortothoracic-bifemoral bypass, two axillofemoral bypasses and one cross-over bypass), 2 died with prosthetic sepsis at 3 and 7 years and 2 others have had a bypass replacement. Overall, at last follow-up, half of the operated patients have died from infection (n=5) or cancer (n=2).


CONCLUSIONS
In reports in the literature, revision and infection after conventional surgery is frequent. There is less risk with the endovascular approach, but it can be only applied for short occlusions.


CONCLUSIONS
Excepting easily accessible occlusions with an apparent minimal risk for percutaneous balloon dilatation, irradiated arteries should be operated on only in case of severe ischemia. Patients with claudication should be treated conservatively because of the high risk of complications for prosthesis implantation with irradiated arteries.
Mellière
D
D
Service de Chirurgie Vasculaire, CHU Henri Mondor, 94010 Créteil, France. Didier.melliere@hmn.ap-hop-paris.fr
Desgranges
P
P
Berrahal
D
D
Allaire
E
E
Cron
J
J
D'audiffret
A
A
Becquemin
J P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000528:radiation effects* / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D001167:Arteritis / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D002404:Catheterization; D002423:Cause of Death; D005260:Female; D005263:Femoral Artery / Q000528:radiation effects* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000528:radiation effects* / Q000601:surgery; D007239:Infections / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D011183:Postoperative Complications; D011832:Radiation Injuries / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D011878:Radiotherapy / Q000009:adverse effects*; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures