Acquired coarctation of the aorta--a long-term complication of irradiation

Percutaneous stenting of acquired thoracic aorta occlusive disease

We report on successful treatment of acquired atherosclerotic coarctation of the thoracic aorta with self-expanding stents via percutaneous approach. The technique and equipment used in the case are discussed.

Radiation-induced arterial disease of the lower limb

We describe a case of radiation injury to the superficial femoral and upper popliteal arteries in a 39-year-old man treated 13 years earlier for an osteosarcoma of the right femur. Following two failed attempts at transluminal angioplasty, a saphenous vein femoropopliteal bypass graft was performed successfully. A comprehensive review of the literature on radiation-induced arterial injury to the limbs is presented with a discussion of the different management options. Percutaneous transluminal balloon angioplasty seems to have no place in the treatment of such lesions.

Acquired coarctation of the aorta

Coarctation of the aorta is usually caused by a congenital narrowing of the aorta. This report describes two children who developed hypertension secondary to an acquired coarctation of the aorta. In one patient the coarctation was temporally related to umbilical artery catheterization and was associated with thrombosis and aneurysmal dilatation of the aorta. In the second patient, the coarctation occurred after surgical aortotomy during the removal of an intrathoracic neuroblastoma. Patients who have interventional damage to the aorta should be periodically examined for the appearance of a coarctation. Although an acquired coarctation of the aorta is an infrequent complication of invasive or surgical procedures, it should be identified since it represents a remediable cause of hypertension in children.

Radiation-induced chronic arterial injury

Acute arterial disruption associated with infection, previous irradiation, and the postoperative state is a well-described entity. The recognition of a chronic form of radiation-induced arterial injury presenting years after therapeutic doses of radiation is less well appreciated. This paper summarizes the vital data obtained by reviewing the literature concerning 162 cases of arterial injury associated with prior radiotherapy. The vessels involved include coronary arteries, the aorta, renal arteries, the extra- and intracranial circulation, the ilio-femoral system, and the upper extremity arteries. A review of the histologic findings, the studies regarding pathogenesis, and the morphology of the lesions found in these 162 patients suggests a disease distinct from the atherosclerotic process.

Renal artery stenosis and hypertension after abdominal irradiation for Hodgkin disease. Successful treatment with nephrectomy

Hypertension secondary to stenosis of the left renal artery developed in a thirteen-year-old male six years after completion of inverted Y irradiation (3,600 rad) for abdominal Hodgkin disease. Surgical treatment with nephrectomy resulted in control of the hypertension without the use of antihypertensive agents. We review the literature for this unusual complication of abdominal irradiation, and recommend that a 99mTc-DMSA renal scan, selective renal vein sampling for renin determinations, and renal arteriography be performed on any patient in whom hypertension develops following abdominal irradiation in childhood.

Coarctation of the aorta from a mediastinal germ cell tumor: a case report

A 20-yr-old male had compression of the thoracic aorta by a large malignant mediastinal germinoma. The symptoms and signs that simulated coarctation of the aorta included hypertension, markedly decreased femoral pulses, and a systolic murmur that radiated to the back. Following X-ray therapy, the femoral pulses were palpable and the blood pressure became normal. To our knowledge, compression of the aorta by a malignant teratocarcinoma with manifestations mimicking coarctation of the aorta has not been reported.

Irradiation injury to large arteries

Four cases of irradiation injury to large arteries are presented and the literature is reviewed. Three patterns of injury have emerged. 1. Intimal damage resulting in mural thrombosis presenting within 5 years of irradiation. 2. Fibrotic occlusion presenting within 10 years of injury. 3. A predisposition to the development of atheroma together with periarterial fibrosis associated with a latent interval of 20 or more years. The treatment of choice is a bypass procedure of the arterial lesion.