NOTE: The study was limited to noncoronary sites, where the age of presentation is more striking.
Risk factors:
(1) dose of radiation (>= 30 Gy)
(2) time since the radiation therapy (median time 15 years)
(3) risk factors for atherosclerosis (obesity, hypertension, diabetes, smoking, hyperlipidemia)
The atherosclerotic disease may present in relatively young patients (under the age of 60 years), even after moderate radiation doses (30-50Gy).
Presentations:
(1) carotid artery: stroke, amaurosis fugax, distortion of visual field
(2) mesenteric artery: postprandial abdominal pain, intestinal angina
(3) renal artery: hypertension
(4) subclavian artery: axillary edema or claudication upper extremity
(5) iliac artery: claudication in buttock or lower extremity
Recommendations:
(1) monitor arteries in the radiation fields for bruits, which preceded ischemic events
(2) aggressively control risk factors for atherosclerosis
Additional suggestions would include:
(3) consider antiplatelet therapy
(4) consider early vascular evaluation
(5) aggressive evaluation of possible ischemic events
(6) early vascular intervention (stent, angioplasty, bypass, endarterectomy)
Differential diagnosis:
(1) arterial hypoplasia
(2) necrosis with rupture
