Iliac atherosclerotic occlusive disease complicating radiation therapy for cervix cancer: a case series

Diagnosis and management of atherosclerotic occlusive disease complicating radiation therapy for squamous carcinoma of the cervix (SCC) are not well known.

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.

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.