1/9. Presentation and revascularization outcomes in patients with radiation-induced renal artery stenosis.This study analyzed the initial presentation and revascularization outcomes of patients with radiation-induced renal artery stenosis, a rare complication of therapeutic irradiation. Of 11 patients with renal artery stenosis after irradiation, 7 patients fulfilled the following criteria: normotension before irradiation, radiation dose greater than 25 grays delivered to the renal arteries, associated perirenal radiation-induced lesions, and absence of arterial disease outside the radiation field. The median age at irradiation was 30 years, and the median local irradiation dose was 40 grays. The median time from irradiation to referral was 13 years. All patients were hypertensive at referral, with a median blood pressure (BP) of 171/102 mm Hg and median treatment score of two. The median glomerular filtration rate was 67 mL/min. Two patients had bilateral stenoses and 1 patient had stenosis affecting a single kidney. Stenoses were proximal in 6 patients and truncal in 1 patient, and all had the appearance of atherosclerotic stenosis. Percutaneous transluminal renal artery angioplasty (PTRA) was successful in 5 patients, but required multiple insufflations. PTRA failed in 1 patient, who subsequently underwent an aortorenal bypass. After a median follow-up of 36 months, 2 patients had died of noncardiovascular causes and 4 patients remained hypertensive, with a median BP of 136/85 mm Hg and median treatment score of two. No restenosis occurred, but aneurysms developed at the site of angioplasty in 1 patient. If hypertension occurs even decades after irradiation, a radiation-induced renal artery stenosis should be sought in patients who have undergone abdominal irradiation.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
2/9. radiation-induced arteriopathy. A report of two cases.radiation is a rare cause of occlusive arterial disease. It can manifest with a variety of symptoms. The pathophysiology of radiation-induced arterial injury has not been clearly elucidated. Surgically correctable cases pose a technical challenge and there appears to be high incidence of late graft infection in areas of irradiated tissue. Two case reports and a brief review of the literature are presented.- - - - - - - - - - ranking = 0.14285714285714keywords = radiation-induced (Clic here for more details about this article) |
3/9. ophthalmic artery occlusion secondary to radiation-induced vasculopathy.A 35-year-old man with neurofibromatosis type 1 (NF1) had a left ophthalmic artery occlusion that caused no light perception OS 28 years after having been treated with external beam radiation therapy for a presumed glioma of the right optic nerve and chiasm. Clinical and imaging findings were consistent with radiation-induced cerebral vasculopathy. This ophthalmic complication has never been reported, despite the common occurrence of severe carotid-ophthalmic artery junction stenosis after radiation in NF1 patients. Even though modern radiation techniques limit collateral damage, this modality should be used with discretion in NF1 patients, given the vulnerability of their immature cerebral vasculature to radiation.- - - - - - - - - - ranking = 0.71428571428571keywords = radiation-induced (Clic here for more details about this article) |
4/9. Primary stenting of bilateral radiation-induced external iliac stenoses.radiation-induced arteritis is a described rare complication of radiotherapy, particularly in patients with cancer. We report bilateral radiation-induced arteritis leading to stenoses in the external iliac arteries, which was treated with primary percutaneous arterial stenting, and review the current literature on the topic.- - - - - - - - - - ranking = 0.71428571428571keywords = radiation-induced (Clic here for more details about this article) |
5/9. Percutaneous transluminal angioplasty of nonatherosclerotic lesions.Percutaneous transluminal angioplasty (PTA) was attempted on 16 nonatherosclerotic lesions in 14 patients. dilatation was initially successful in 4/4 cases with renal artery stenosis due to fibromuscular dysplasia (three) and takayasu arteritis (one); all patients became normotensive and remain normotensive on no antihypertensive medications, at up to 12 months follow-up. PTA was technically successful in 4/5 transplant renal artery stenosis; these four patients remain normotensive or almost normotensive on no or markedly reduced antihypertensive medications, at up to 14 months followup. Initial success was obtained in 3/3 lesions involving vascular grafts; in one, the patient became and remained asymptomatic for the remaining 5 months he lived; in another, occlusion of the dilated segment and the graft occurred 8 months after PTA; and in the third, symptoms and signs of the limb ischemia returned within 24 hr of PTA. PTA was initially successful in a patient with recurrent celiac artery stenosis after surgery for median arcuate ligament syndrome; she has remained free of symptoms for 18 months. In a patient with three radiation-induced stenoses, PTA was initially successful; this patient is asymptomatic at 20 months follow-up. The medial type of fibromuscular dysplasia dilates most easily, suggesting a concentric stretching and some shearing of the fibrous tissue, which then heals in its dilated state. Intimal fibroplasia may be eccentric, and concentric stretching during dilatation may not be possible, leading to less satisfactory results. radiation-induced stenosis involves periarterial fibrosis and arterial wall thickening, and the results in PTA of many of these lesions may be less satisfactory than reported here. The responsiveness of graft stenoses will vary with the cause; anastomotic stenoses will probably dilate easily, for they involve either concentric intimal proliferation, or a small degree of periarterial fibrosis; graft stenoses surrounded by dense fibrous tissue may respond initially to PTA, but the long-term results will probably be poor due to recurrent graft constriction.- - - - - - - - - - ranking = 0.14285714285714keywords = radiation-induced (Clic here for more details about this article) |
6/9. Occlusive arteriopathy and brain tumor.Four cases with the association of occlusive arteriopathy and brain tumor are presented. A clinical analysis of these cases and cases reported in the literature revealed that occlusive arteriopathy at the base of the brain was often associated with a slowly growing basal tumor in children. Possible causes of occlusive arteriopathy in these cases were compression of the circle of willis by a slowly growing basal tumor, secondary artial occlusive changes by radiation therapy for a basal tumor, or vasculopathy associated with neurocutaneous syndrome. Symptoms of sudden onset or episodic nature suggest the presence of occlusive arteriopathy rather than the mass effect of a tumor. cerebral angiography is mandatory whenever computerized tomography (CT), performed to rule out recurrence of a basal tumor, shows an ischemic lesion with low-density areas without any evidence of mass effect of the tumor. cerebral angiography is also necessary when a basal tumor is suspected in children, particularly in cases associated with neurocutaneous syndrome and a basal tumor. Care should be taken not to scarify the abnormal vascular network at the base of the brain at the time of operation, because it is considered to be functioning as collateral circulation. The potential hazards of radiotherapy to radiation-induced occlusive changes of the circle of willis must be considered in treating a benign basal brain tumor in children. Even in adults, repeated large doses of irradiation could cause occlusive arteriopathy.- - - - - - - - - - ranking = 0.14285714285714keywords = radiation-induced (Clic here for more details about this article) |
7/9. Axillary-contralateral brachial artery bypass for radiation-induced occlusion of the subclavian artery.Symptomatic occlusion of the subclavian artery is a rare complication of radiation therapy for carcinoma of the breast. The first case of revascularization of this entity using saphenous vein was described in 1974. A total of only 24 patients have been reported in the English literature, of whom 14 have undergone successful arterial reconstruction. Three additional cases of occlusion of the subclavian artery 27, 18 and 7 years after radical mastectomy and postoperative radiotherapy are reported. These patients presented with pain, coldness, paresthesia and absence of pulses in the affected arm, and angiographic evidence of complete occlusion of the subclavian artery. All patients underwent axillary-contralateral brachial artery reconstruction using a 6-mm polytetrafluoroethylene graft tunneled subcutaneously through the previously irradiated area. In each case, the patient noted complete resolution of symptoms with the return of palpable distal pulses. One patient had a thrombosed graft 5 weeks after initial surgery and underwent successful thrombectomy. There were no complications associated with the subcutaneous tunnel or the production of a subclavian steal syndrome. Although there are other possibilities for the origin of the bypass, this technique avoids extensive dissection in previously irradiated areas and does not require complicated dissection of the subclavian artery or clamping of the carotid artery.- - - - - - - - - - ranking = 0.57142857142857keywords = radiation-induced (Clic here for more details about this article) |
8/9. Intracranial arterial occlusion associated with high-activity iodine-125 brachytherapy for glioblastoma.We describe two patients who developed devastating strokes due to intracranial arterial occlusion 15 weeks and 97 weeks following high dose stereotactic iodine-125 brachytherapy for glioblastoma multiforme. In both cases the occlusion was within the implant volume at points receiving 110-281 Gy and there was no other evidence of significant atherosclerosis in the patients. We therefore conclude that these complications were a direct result of the brachytherapy. The phenomenon of radiation-induced occlusion of large cerebral arteries is reviewed.- - - - - - - - - - ranking = 0.14285714285714keywords = radiation-induced (Clic here for more details about this article) |
9/9. Progressive cerebral occlusive disease after hypothalamic astrocytoma radiation therapy.An 18 year-old woman received radiation therapy for hypothalamic astrocytoma at the age of 11 years. She developed progressive cerebral occlusive vascular disease with moyamoya vessels formation in both carotid systems. Apart from diabetes mellitus, she had no other risk factors for occlusive cerebrovascular disease. The site of occlusion was confined to the field of radiation and the development of moyamoya vessels strongly suggestive of a radiation-induced cause. radiation therapy around the sella and parasellar region appears to be the most common risk factor for this vasculopathy. Progressive irradiation-induced cerebral vasculopathy is due to accelerated atherosclerosis.- - - - - - - - - - ranking = 0.28571428571429keywords = radiation-induced (Clic here for more details about this article) |