Localized arterial occlusions in patients treated with pelvic field radiation for cancer

Five patients, previously treated with pelvic irradiation for cancer of the cervix uteri, ovaries or bladder are presented. They developed occlusions of the distal aorta and/or the iliac arteries 2 to 6 years after irradiation. The presenting symptoms caused by the vascular obstructions were claudication or rest pain. All patients were operated upon with revascularization procedures and thereby relieved from their symptoms. One vascular graft occluded but reoperation was successful. The mechanism by which radiation causes atherosclerosis is discussed. All patients were heavy cigarette smokers. The patients with signs of atherosclerosis outside the irradiated area were the ones with the shortest time interval between radiation and symptoms of ischaemia. It is proposed that irradiation acts synergistically to other atherogenetic factors and this should be kept in mind when radiation therapy is planned in patients with high risk of developing atherosclerosis.