Key result
In patients with radiation-induced lower-limb arteriopathy, 16% presented with symptom recurrence and 8% required reintervention, with no clear evidence favoring open over endovascular treatment.
Why the study?
Radiation-induced arteriopathy may become more common, but evidence regarding treatment options for lower-limb cases remains lacking.
Systematic Review (n=43)
Answers are grounded in this paper and cite their sources.
Radiation-induced lower-limb arteriopathy is a rare condition with a long latency period (median 12 years) that requires close, long-term follow-up due to a significant risk of symptom recurrence.
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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Grandhomme et al. (2021) conducted a systematic review in Radiation-induced lower-limb arteriopathy (n=43). Open or endovascular surgery was evaluated on Treatment outcomes including symptom recurrence and reintervention. In patients with radiation-induced lower-limb arteriopathy, 16% presented with symptom recurrence and 8% required reintervention, with no clear evidence favoring open over endovascular treatment.
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