1/8. Mediastinal irradiation: A risk factor for atherosclerosis of the internal thoracic arteries.Previous radiotherapy to the thorax is a risk factor for coronary artery disease. patients with radiation-induced atherosclerosis tend to be young and frequently have lesions involving the coronary ostia and left anterior descending artery. Bypass is often the most suitable method of revascularization, and given the young age of the patient, arterial conduits would be considered superior to vein grafts. However, the internal thoracic arteries can lie within the radiation field and may not be free of atherosclerosis. A 40-year-old man who required coronary artery bypass grafting for multivessel coronary artery disease 11 years following radiotherapy for Hodgkin's lymphoma is reported. Preoperative angiography showed that the right internal thoracic artery had significant atherosclerosis and was unsuitable as a conduit.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
2/8. Iliac atherosclerotic occlusive disease complicating radiation therapy for cervix cancer: a case series.BACKGROUND: diagnosis and management of atherosclerotic occlusive disease complicating radiation therapy for squamous carcinoma of the cervix (SCC) are not well known. CASES: A series of four patients who underwent medical or surgical treatment of radiation-induced artery disease were identified. Chronic right iliac artery occlusion was seen in one patient 7 years after external irradiation for SCC and was treated by a femorofemoral bypass. Acute arterial occlusion was seen in three patients. One patient developed right foot ischemia 2 years after external irradiation for SCC which was treated by a right axillofemoral bypass. One patient developed a left toe necrosis 2 years after external irradiation for a recurrence of SCC which was treated by a percutaneous artery dilatation. One patient developed, 3 years after external irradiation for SCC, a subacute ischemia of the left leg on the first postoperative day after a rectal resection. It was treated by vasodilators, calcium inhibitors, and anticoagulants. CONCLUSIONS: diagnosis of radiation-induced atherosclerotic occlusive disease complicating radiation therapy for SCC is easy but treatment is difficult. Long-term results of arterial dilatation are limited and extraanatomic bypass with allograft is the treatment of choice whenever feasible. However, because of poor long-term results, surgery should be attempted only in the case of severe ischemia.- - - - - - - - - - ranking = 2keywords = radiation-induced (Clic here for more details about this article) |
3/8. Synergism between radiotherapy and vascular risk factors in the accelerated development of atherosclerosis: a report of three cases.radiotherapy is commonly used in the management of testicular tumors. However, to date the risk of radiation-induced vascular occlusive disease in men following radiotherapy for testicular cancer has not been regarded as a major factor in their long-term care. Several animal studies have shown the importance of established vascular risk factors such as hypercholesterolemia and hypertension in the pathogenesis of radiation-induced atherosclerosis. This report presents three cases of premature chronic iliofemoral arterial disease presenting 5,13, and 16 years following exposure to therapeutic irradiation for the treatment of testicular cancer. The patients were in the age group of 40-45 years and all demonstrated associated known atherosclerotic risk factors. The patients had received radiotherapy in the dose of 3,500-4,000 rads in a standard "dog-leg" fashion to the ipsilateral aortoiliac lymphatic chain. Our results showed that young men treated with radiotherapy for testicular cancer may be targeted from the outset for atherosclerotic risk factor reduction to minimize the risk of development of late chronic occlusive arterial disease. It may be that a cohort of men so treated with historical regimes of radiotherapy and now entering middle age should be screened for arterial disease and risk factor reduction.- - - - - - - - - - ranking = 2keywords = radiation-induced (Clic here for more details about this article) |
4/8. Irradiation-induced atherosclerosis: a factor in therapeutic planning.Early primary head and neck cancers (stages I and II) and occult metastatic neck disease have caused debate regarding the choice between surgery and irradiation. The arguments for each are reviewed with a new consideration: the acceleration and/or induction of carotid atherosclerosis in irradiated patients. We present clinical case reports (n = 9), a retrospective clinical evaluation for the occurrence of carotid atherosclerosis in irradiated head and neck cancer patients (n = 57) and a comparison study of the extent and distribution of atherosclerosis in irradiated (n = 29) and nonirradiated head and neck cancer patients controlled for age, blood pressure, and tobacco use. The results show that carotid atherosclerosis is found in a wider anatomic distribution and to a greater extent in irradiated than in nonirradiated patients. We conclude that carotid atherosclerosis is induced and/or accelerated by neck irradiation. The implications as they relate to choice of treatment, to pretreatment evaluations, and to long-term follow-up are discussed.- - - - - - - - - - ranking = 4keywords = radiation-induced (Clic here for more details about this article) |
5/8. Management of radiation-induced accelerated carotid atherosclerosis.patients with long survival following cervical irradiation are at risk for accelerated carotid atherosclerosis. The neurologic presentation in these patients mimics naturally occurring atheromatous disease, but patients often present at younger ages and with less concurrent coronary or systemic vascular disease. hypercholesterolemia also contributes to this accelerated arteriosclerosis. Angiographic findings in this disorder include disproportionate involvement of the distal common carotid artery and unusually long carotid lesions. Pathologic findings include destruction of the internal elastic lamina and replacement of the normal intima and media with fibrous tissue. This article describes two surgical patients with radiation-induced accelerated carotid atherosclerosis who typify the presentation and characteristics of this disease.- - - - - - - - - - ranking = 5keywords = radiation-induced (Clic here for more details about this article) |
6/8. radiation-induced accelerated coronary arteriosclerosis.There is a paucity of information on radiation-induced coronary heart disease. A young patient with myocardial infarction following mediastinal irradiation is described. The role of radiotherapy and chemotherapy on the subsequent development of coronary heart disease is discussed.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
7/8. 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 = 1keywords = radiation-induced (Clic here for more details about this article) |
8/8. Precocious myocardial infarction after radiation treatment for Hodgkin's disease.A 26-year-old man received extensive cardiac radiation in the course of treatment of mediastinal Hodgkin's disease, and six years later, he experienced an acute myocardial infarction. Angiographic studies demonstrated extensive atherosclerotic abnormalities in the coronary arterial system. It is suggested that radiation-induced injury was a provocation of these precocious arterial abnormalities.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |