J Korean Diabetes.  2014 Jun;15(2):124-128. 10.4093/jkd.2014.15.2.124.

Radiation Induced Peripheral Arterial Disease associated with Diabetes which Initially Considered as Diabetic Foot Disease

• Lee WH
• Heo JJ
• Yeo GE
• Choi YS
• Park YH
• Kwon SK

• KMID: 2173905
• DOI: http://doi.org/10.4093/jkd.2014.15.2.124

Abstract

Therapeutic high-dose radiation can induce atherosclerotic changes of affected arteries. Radiation-associated atherosclerotic diseases of coronary, carotid and subclavian arteries have been demonstrated for years in cancer survivors, but peripheral arterial disease (PAD) associated with radiation is rarely reported. PAD is one of the major macrovascular complications of diabetes and is associated with morbidity and increased mortality. We experienced a case of PAD associated with radiation therapy in a 65-year-old diabetic female patient who had undergone cervical cancer treatment 19 years prior. Computed tomographic angiogram showed occlusion and stenosis from common iliac arteries to superficial femoral arteries. However, both infrapopliteal arteries that are commonly involved in diabetes associated PAD were preserved. She was successfully treated with percutaneous angioplasty combined with femoro-femoral bypass operation. Based on the extent and severity of arterial stenosis in this non-smoking diabetic woman who had a history of high-dose radiation to her pelvis, we concluded that atherosclerotic lesions in this patient were caused by high-dose pelvic irradiation and then exacerbated by diabetes. Therefore, special attention should be given to diabetic patients with history of pelvic irradiation with regard to development of atherosclerosis of peripheral arteries, especially in the pelvic area.

Keyword

Peripheral arterial disease; Diabetes mellitus; Radiation; Diabetic foot

MeSH Terms

Aged
Angioplasty
Arteries
Atherosclerosis
Constriction, Pathologic
Diabetes Mellitus
Diabetic Foot*
Female
Femoral Artery
Humans
Iliac Artery
Mortality
Pelvis
Peripheral Arterial Disease*
Subclavian Artery
Survivors
Uterine Cervical Neoplasms

Figure

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  Fig. 1. Lower extremity three-dimensional computed tomographic angiography. (A) Total occlusion from the common iliac artery to the common femoral artery, multifocal mild stenosis in the superficial femoral artery of the right leg, and stenosis in the distal portion of the left external iliac artery. (B) No significant stenosis was shown in either infrapopliteal artery, which are commonly involved in diabetic peripheral arterial disease.

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  Fig. 2. Lower extremity computed tomographic angiography. Femoro-femoral bypass graft was placed and showed patency. Stenosis was noted at the distal portion of the left external iliac artery (white arrow).

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  Fig. 3. Lower extremity angiography during angioplasty. (A) A catheter was placed in the left common iliac artery. Greater than 90% stenosis was demonstrated at the distal portion of the left external iliac artery. (B) After angioplasty and stent insertion, stenosis was improved and blood flow was restored.

Reference

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