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      Arterite actínica de artéria subclávia: relato de caso e revisão de literatura Translated title: Actinic arteritis of subclavian artery: case report and literature review

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          Abstract

          Diversas são as complicações possíveis da radioterapia na adjuvância do tratamento de neoplasias. Lesões actínicas de artéria subclávia em pacientes submetidos a este tipo de tratamento para neoplasia de mama são complicações conhecidas, porém com poucos relatos de casos publicados. No presente relato, descrevemos um caso de oclusão de artéria subclávia direita em paciente submetida à radioterapia para tratamento de neoplasia de mama, tratada com a revascularização convencional, com interposição de enxerto de politetrafluoretileno (PTFE). Na revisão da literatura realizada, foram encontrados doze casos descritos que evidenciaram diferentes opções terapêuticas. Concluímos que a arterite actínica de artéria subclávia é uma doença incomum, entretanto sua hipótese deve ser aventada em todos os pacientes com isquemia de membro superior já submetidos a tratamento de radioterapia.

          Translated abstract

          Several complications may occur as a consequence of adjuvant radiotherapy for cancer. One of these complications is actinic lesions of the subclavian artery in patients undergoing radiotherapy for breast cancer; however, there are few reported cases. In the present case report, we describe a case of right subclavian artery occlusion in a patient undergoing radiotherapy for breast cancer. Occlusion was treated by means of conventional artery bypass with interposition graft with polytetrafluoroethylene (PTFE). Our extensive review of the literature revealed 12 reported cases showing the different treatment options performed. We concluded that actinic arteritis of the subclavian artery is an uncommon condition; however, its presence should be considered in all patients with upper limb ischemia who underwent radiotherapy.

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          Most cited references20

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          Cardiovascular effects of breast cancer radiotherapy.

          Cardiac toxicity has been implicated as the primary reason for excess non-breast cancer mortality in early breast cancer radiotherapy studies. Refinements in radiotherapy techniques have allowed for a considerable reduction of this risk in the majority of breast cancer patients. Recent large population-based studies confirmed an increase of cardiovascular death risk in patients irradiated for cancer of the left breast and in individuals exposed to relatively low (hitherto believed to be of no cardiovascular disease risk) doses of radiation, such as atomic bomb survivors or patients treated for various benign conditions. The issue of potential radiation-related cardiac damage may also be assuming a new significance due to the widespread use of other cardiotoxic agents, such as anthracyclines, paclitaxel and trastuzumab. The aim of this review is to summarize and critically analyze the available evidence on the impact of ionizing radiation on the cardiovascular system, with special attention to recent data demonstrating previously unrecognized adverse effects. This review discusses the pathology of radiation-related cardiovascular disease, its clinical presentation, risk factors and methods of assessment, as well as technical developments minimizing cardiac exposure. Epidemiological data are presented on the incidence of radiation-induced heart disease and cardiovascular mortality in various populations of patients irradiated for breast cancer and in individuals exposed to low radiation doses. Additionally, non-cardiac radiation-related vascular morbidity and mortality in breast cancer patients are addressed.
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            Carotid artery revascularization through a radiated field

            Extracranial carotid stenosis is a complication of external head and neck irradiation. The safety and durability of carotid artery revascularization through a radiated field has been debated. We describe the immediate and long-term results in a series of 27 consecutive patients who received treatment over 12 years.
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              Subclavian Artery Occlusion Following Radiotherapy for Carcinoma of the Breast

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                Author and article information

                Journal
                jvb
                Jornal Vascular Brasileiro
                J. vasc. bras.
                Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) (Porto Alegre, RS, Brazil )
                1677-5449
                1677-7301
                December 2012
                : 11
                : 4
                : 329-333
                Affiliations
                [01] São Paulo SP orgnameFaculdade São Camilo Brasil
                [02] São Paulo SP orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina Brasil
                Article
                S1677-54492012000400014 S1677-5449(12)01100400014
                d2ee3b36-0105-4976-832a-104c9cf4ce9c

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 14 March 2012
                : 24 August 2012
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 5
                Product

                SciELO Brazil

                Categories
                Relatos de Caso

                efeitos de radiação,subclavian artery,radiation effects,breast cancer,artéria subclávia,câncer de mama

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