Delayed Radiation-Induced Changes in Arteries

 

Types of radiation-induced injury:

(1) stenosis due to hyperplasia of intima, media, and/or adventitia

(2) hypoplasia

(3) thrombosis

(4) ischemic necrosis in the arterial wall

(5) aneurysm

(6) rupture with hemorrhage

(7) nodular widening and tortuosity

 

Artery	Effect
renal artery	hypertension
carotid artery	stroke
coronary artery	myocardial infarction
mesenteric	ischemic enteropathy
aorta	variable (renal, intestine, extremities)
iliac	leg ischemia
superficial femoral	leg ischemia
subclavian	arm ischemia

 

Onset may be from 3 months to many years after the radiation therapy.

 

Factors affecting outcome:

(1) age of the patient at the time of exposure (more common if > 40 years of age; hypoplasia more common in infants)

(2) intensity of radiation exposure

(3) collateral circulation to end organ

(4) concurrent vascular disease (atherosclerosis, other)

 

Differential diagnosis:

(1) vascular disease unrelated to radiation therapy (pure atherosclerosis, etc.)