Beta radiation in the treatment of in-stent restenosis of an in situ saphenous vein bypass graft A case report.
We describe a case of instent restenosis in a femoral-distal saphenous vein bypass graft successfully treated with brachytherapy. A 45-year-old insulin-requiring diabetic woman underwent an in-situ femoral-anterior tibial bypass graft for a non-healing ischemic ulcer. Despite a technically successful percutaneous transluminal angioplasty and endovascular stenting of a retained valve within the threatened graft, the wound failed to heal. At the 1-month follow-up, instent restenosis was documented and successful cutting balloon angioplasty, complemented by adjunctive beta-irradiation was successfully performed. Clinical and hemodynamic success was achieved, with prompt ulcer healing and intermediate-term graft patency maintained on surveillance duplex ultrasound follow-up. We review the literature on radiation therapy in the management of peripheral arterial disease and discuss therapeutic options in the management of restenosis.
Lotun
Kapildeo
K
Division of Vascular Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA.
Soukas
Peter
P
Cho
Sung
S
O'Donnell
Kevin
K
Griben
André
A
Irwin
William T
WT
Schainfeld
Robert M
RM
D000800:Angioplasty, Balloon / Q000379:methods*; D001610:Beta Particles / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000209:etiology / Q000628:therapy; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D018714:Radiotherapy, Adjuvant; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D015607:Stents / Q000009:adverse effects; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods; D014654:Vascular Patency