Arteritis following protracted supervoltage pelvic irradiation. Report of a case

Arterial injuries attributed to irradiation are most frequent about the head and neck and are invariably triggered by infection, infarction, or fistulas. Vascular changes from surgery or invasive behavior of tumor can also contribute to local vascular insufficiencies. It is quite possible in humans that irradiation can accelerate the aging processes in atherosclerotic vessels. The case reported is unusual in that rather routine, postoperative, pelvic irradiation was given for pelvic soft tissue and bone carcinomatosis, only to be followed in 6 months to 1 year by vascular insufficiency symptoms in the lower extremities. Symptoms progressed to the point that surgical correction was contemplated, but then postponed when signs and symptoms improved following cessation of smoking. The patient had had no previous history of a Reynaud's diathesis. Although histologic proof is lacking (patient continues to do generally quite well 5 years following palliative treatment), field films and subsequent angiographic abnormalities can be superimposed almost exactly. Neither author is entirely happy with the diagnosis of 'radiation arteritis' for the reasons discussed, but the coincidence of radiation fields and areas of arterial damage makes the role of irradiation indicating.