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Regarding “Percutaneous transluminal angioplasty for emboligenic arterial lesions after radiotherapy of axillary arteries”

1996; Elsevier BV; Volume: 24; Issue: 2 Linguagem: Inglês

10.1016/s0741-5214(96)70110-6

1097-6809

Giovanni Lorenzi, A Rolli, Maurizio Domanin, Piergiorgio Sala,

Coronary Interventions and Diagnostics

We are writing in regard to your published article entitled “Percutaneous transluminal angioplasty for emboligenic arterial lesions after radiotherapy of axillary arteries” by Veyssier-Belot et al. (J Vasc Surg 1995;22:118-9). The authors have reported the good results of percutaneous transluminal angioplasty (PTA) in these kind of lesions. Our experience support these data; moreover, we suggest the use of endovascular stenting in the presence of fibrotic degeneration of the arterial wall, often complicated by low-grade calcifications. The use of intravascular ultrasound (IVUS) for accurate intraoperative monitoring of the endovascular treatment of these particular arterial lesions is also indicated. A 46-year-old woman was admitted in our Institute for symptomatic bilateral thigh and leg claudication in February 1993. Four years earlier she had undergone an anterior resection of the rectum for a metastasized adenocarcinoma. Fractioned irradiation of the pelvis was administered in an adjuvant setting for a total dose of 60 Gy. Preoperative angiography (Fig. 1) showed a tight stenosis of the external iliac artery on the left side and an obstruction of the external iliac artery on the right side, with normal patency of the other regional vessels.Intraoperative IVUS confirmed stenosis caused by intimal hyperplasia and fibrosis of the media layer (Fig. 2).Fig. 2Predilatation IVUS monitoring.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The patient was submitted to PTA of the left external iliac artery with a 7-mm-x-4-cm Olbert catheter (Meadox -Surgimed, Stenlose, Denmark) and subsequent insertion of two P304 Palmaz stents (Johnson & Johnson Intervention Systems Co., Warren, N.J.). A left-to-right femorofemoral cross-over bypass was performed in the same operative session using a 6-mm polytetrafluoroethylene graft. The intraoperative IVUS control confirmed the good expansion of the stents (Fig. 3).The postoperative course was uneventful and the patient was discharged on antiplatelet therapy. Six months after surgery the patient is still asymptomatic with normal tibial pulses. Radiation-induced arteriopathy is an ingravescent chronic lesion involving a myointimal hyperplasia and a remarkable fibrosis of the arterial outer layers resulting in stenosis and obstruction of the irradiated vessels. Based on these findings, we believe that a mechanical support, such as an endovascular stent is to be favored to prevent the immediate elastic recoil caused by fibrotic degeneration and to contrast the long-time evolution of this inflammatory chronic lesion. The proximal and the distal end of the stent must be placed on healthy tissue. The endovascular procedures are better supported by accurate intraoperative IVUS monitoring to define the real limits of the lesion and to control complete expansion of the stent. 24/41/72198