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Grandhomme J, Kuntz S, Schwein A, Georg Y, Steinmetz L, Thaveau F, Chakfe N, Lejay A. Radiation-induced lower-limb arteriopathy: report of 4 cases and systematic literature review. INT ANGIOL 2021; 40:222-228. [PMID: 33660497 DOI: 10.23736/s0392-9590.21.04606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Radiation-induced arteriopathy (RIA) is a rare complication but may become more common due to the increased use of radiotherapy and the prolonged survival of patients. There is still a lack of evidence concerning treatment options. The aim of this study is to review reported cases of lower-limb RIA in order to provide guidelines for management. EVIDENCE ACQUISITION We reported 4 cases treated for lower limb RIA and performed a systematic literature review without time limitation in the Medline database using the MeSh tems "iliac artery/radiation effects" OR "femoral artery/radiation effects." Main outcomes of interest were radiation dose, time before symptoms, symptoms, involved vessels, treatment and outcome. EVIDENCE SYNTHESIS Twenty-five studies were included, reporting a total of 43 patients. Median time between irradiation and symptoms was 12 years (range: 9 days-49 years), with a median irradiation dose of 40Gy. Clinical presentation was claudication in 18 patients (52%), critical limb threatening ischemia (CLTI) in 4 patients (11%), acute limb ischemia (ALI) in 3 patients (9%) and hemorrhage in 6 patients (17%), the remaining 4 patients were asymptomatic (11%). Vessels involved were iliac arteries in 65% of the cases, femoropopliteal arteries in 28% of cases and concomitant supra and infrainguinal vessels in 7% of the cases. Claudication was mostly treated by open surgery (62%). Treatment of CLTI included primary amputation (50%), open surgery (25%) or endovascular surgery (25%). ALI was treated medically (33%), by open surgery (33%) or in situ thrombolysis (33%). Hemorrhagic cases or pulsatile masses were mostly treated by open surgery (66%). Follow-up was reported in 26 patients (67%), with mean follow-up of 12 months (range: 2 weeks - 5 years). During follow-up, 16% of these patients presented a recurrence of symptoms, and 8% required a reintervention. CONCLUSIONS There seems to be no evidence for open versus endovascular treatment, but close and long-term follow-up is needed in these patients due to the possible late presentation and recurrence of symptoms after treatment.
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Affiliation(s)
- Jonathan Grandhomme
- Department of Vascular Surgery and Kidney Transplantation, University Hospitals of Strasbourg, Strasbourg, France.,Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire, Strasbourg, France
| | - Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospitals of Strasbourg, Strasbourg, France.,Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire, Strasbourg, France
| | - Adeline Schwein
- Department of Vascular Surgery and Kidney Transplantation, University Hospitals of Strasbourg, Strasbourg, France.,Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire, Strasbourg, France
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospitals of Strasbourg, Strasbourg, France.,Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire, Strasbourg, France
| | - Lydie Steinmetz
- Department of Vascular Surgery and Kidney Transplantation, University Hospitals of Strasbourg, Strasbourg, France.,Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire, Strasbourg, France
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, University Hospitals of Strasbourg, Strasbourg, France.,Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire, Strasbourg, France
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospitals of Strasbourg, Strasbourg, France.,Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospitals of Strasbourg, Strasbourg, France - .,Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire, Strasbourg, France
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Freycon-Tardy L, Verscheure D, Fadel E, Mussot S, Mercier O, Brenot P, Bourkaib R, Fabre D, Haulon S. Secondary Extra-anatomic Infrainguinal Bypass following Lower Limb Tumoral Resection. Ann Vasc Surg 2020; 66:609-613. [PMID: 31978484 DOI: 10.1016/j.avsg.2020.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/06/2020] [Accepted: 01/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Soft tissue malignancy of lower limb can involve femoral triangle by direct tumoral invasion or secondary to ganglionic metastasis. Secondary arterial complications can appear during follow-up after initial tumoral resection and local radiation therapy. The aim of this study is to report our experience of secondary extra-anatomical lower limb revascularization following lower limb oncological resection with femoral bifurcation involvement. METHODS This is a retrospective monocentric study including patients who underwent extra-anatomical iliopopliteal bypass, with a previous treated neoplasia involving homolateral femoral bifurcation. Proximal anastomosis was performed on the iliac artery, tunnelization was made through iliac wing, and distal anastomosis was done on distal superficial femoral or popliteal artery. RESULTS Five patients underwent extra-anatomic iliopopliteal bypass for oncological purpose from 2008 to 2018 at our institution. Mean age at surgery time was 52 years (standard deviation = 19.3). Prosthetic graft was used in all cases. Primitive tumor involved Scarpa triangle in 3 cases (soft tissue sarcomas) and ganglionic metastasis involved Scarpa triangle in 2 cases (epidermoid carcinoma). Clinical presentation was ischemic in 4 cases and hemorrhagic in 1 case. One patient died during hospitalization. Of the 4 survivors, 3 patients had a patent bypass at the end of follow-up (2 had bypass thrombectomy, 1 patient had major amputation). CONCLUSIONS Secondary iliopopliteal bypasses through the iliac wing following lower limb tumoral resection have acceptable results. It is a valid option for limb salvage especially after local radiation therapy and tumoral resection. Multidisciplinary management is necessary to obtain acceptable results and follow-up is mandatory.
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Affiliation(s)
- Léonore Freycon-Tardy
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Dorian Verscheure
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Elie Fadel
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Sacha Mussot
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Olaf Mercier
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Philippe Brenot
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Ryad Bourkaib
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Dominique Fabre
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France.
| | - Stephan Haulon
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
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