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Objectives: Advances in therapeutic radiation techniques have been shown to improve patient survival and lessen associated side-effects. We conducted this study to evaluate the current treatment options for radiation-induced ilio-femoral arterial occlusive disease in cancer survivors.
Methods: We retrospectively reviewed consecutive patients who presented for treatment of radiation-induced ilio-femoral arterial occlusive disease in a tertiary referral cancer center between 07/2010 and 08/2013. Patient demographics, procedure-related complications, and 30-day and intermediate-term outcome were reviewed.
Results: Ten patients had ilio-femoral arterial occlusive disease after radiation treatment (7 women), with median age, 55 year-old (range 39-72). Median follow-up was 14 months (range: 1- 36). Three patients were active smokers, 3 former and 4 never smoked. Two patients had non-insulin diabetes. Nine patients presented 3 years or more after completing radiation treatment (median interval was 8 months; 7 with rest pain or non-healing wound, 2 disabling claudication), and 1 had acute limb-threatening ischemia when completing radiation. Two most common types of cancer were: cervix (4), anal canal (2); other (4). Four patients had endovascular revascularization, 3 surgical bypass, 2 hybrid interventions, and one on medical therapy. Revascularization was successful in 9/9 patients and all survived at 30-days. No patient required amputation. One patient died at 20 months after revascularization from chronic relapsing infectious complications related to her oncologic surgery. Two patients who had iliac stenting required successful re-interventions at 12 and 18 months (both were active smokers).
Conclusion: Our study shows that most cancer survivors with radiation-induced ilio-femoral arterial occlusive disease present several years after radiation treatment and have good outcome following either endovascular or surgical revascularization.