Management of extremity ischemia secondary to radiation therapy

The protocols for treating neoplasms often involve the use of radiation therapy either as the primary treatment or as an adjunct to surgery or chemotherapy. Numerous adverse reactions can occur secondary to radiation therapy. A well known side effect is radiation induced occlusive lesions and the enhancement of normally occurring atherosclerosis. All cases of extremity ischemia in the Pennsylvania Hospital Vascular Surgical Registry, from January 1, 1967 to December 31, 1984, were reviewed. This study involves six patients who developed ischemia secondary to radiation induced arterial injury. Five cases involved the lower extremities (iliac arteries) and one case involved the upper extremity (subclavian artery). The pathologic changes occurring in these irradiated arteries and their relationship to atherosclerosis is discussed. All patients were successfully managed by arterial bypass procedures.