Arterial Complications in Patients with Cancer

  • Tam T. T. HuynhEmail author
  • Hue T. Cao
  • Susana G. Palma
  • Karen C. Broadbent


Complications of peripheral arterial disease in cancer patients are associated with increased morbidity and mortality. Medical management with modification of vascular risk factors remains the first line of treatment for cancer patients with arterial occlusive disease. Endovascular or surgical revascularization is indicated for patients who have critical limb ischemia or disabling claudication symptoms. In this article, we review the management of peripheral arterial disease in cancer patients, and present a series of common and rare case examples of arterial complications that can occur during or after oncologic therapy.


Angiography Angioplasty Arterial disease Cancer Endarterectomy Limb ischemia PAD Radiation Stenting Vascular 


  1. 1.
    Levitan N, et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine (Baltimore). 1999;78(5):285–91.CrossRefGoogle Scholar
  2. 2.
    Sorensen HT, et al. Prognosis of cancers associated with venous thromboembolism. N Engl J Med. 2000;343(25):1846–50.CrossRefPubMedGoogle Scholar
  3. 3.
    Prandoni P, Falanga A, Piccioli A. Cancer and venous thromboembolism. Lancet Oncol. 2005;6(6):401–10.CrossRefPubMedGoogle Scholar
  4. 4.
    Herrmann J, et al. Vascular toxicities of cancer therapies: the old and the new--an evolving avenue. Circulation. 2016;133(13):1272–89.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Lenneman CG, Sawyer DB. Cardio-oncology: an update on cardiotoxicity of cancer-related treatment. Circ Res. 2016;118(6):1008–20.CrossRefPubMedGoogle Scholar
  6. 6.
    Al-Kindi SG, Oliveira GH. Prevalence of preexisting cardiovascular disease in patients with different types of cancer: the unmet need for onco-cardiology. Mayo Clin Proc. 2016;91(1):81–3.CrossRefPubMedGoogle Scholar
  7. 7.
    Di Nisio M, et al. Arterial thrombosis in ambulatory cancer patients treated with chemotherapy. Thromb Res. 2011;127(4):382–3.CrossRefPubMedGoogle Scholar
  8. 8.
    Javid M, Magee TR, Galland RB. Arterial thrombosis associated with malignant disease. Eur J Vasc Endovasc Surg. 2008;35(1):84–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Bennett KM, et al. Outcomes of surgical revascularization for lower extremity arterial thromboembolism in patients with advanced malignancy. J Vasc Surg. 2014;60(4):987–92.CrossRefPubMedGoogle Scholar
  10. 10.
    Morris-Stiff G, Lewis MH. Surgical treatment of acute limb ischaemia in the presence of malignancy. Int J Surg. 2010;8(3):233–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Tsang JS, et al. Acute limb ischemia in cancer patients: should we surgically intervene? Ann Vasc Surg. 2011;25(7):954–60.CrossRefPubMedGoogle Scholar
  12. 12.
    Mouhayar E, et al. Outcome of acute limb ischemia in cancer patients. Vasc Med. 2014;19(2):112–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Allison MA, et al. Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med. 2007;32(4):328–33.CrossRefPubMedGoogle Scholar
  14. 14.
    Peripheral Arterial Disease (PAD) Fact Sheet. 2016. 06/16/2016 [cited 2016 9/05/2016].
  15. 15.
    Hirsch AT, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317–24.CrossRefPubMedGoogle Scholar
  16. 16.
    McDermott MM, et al. Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA. 2001;286(13):1599–606.CrossRefPubMedGoogle Scholar
  17. 17.
    Diehm C, et al. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation. 2009;120(21):2053–61.CrossRefPubMedGoogle Scholar
  18. 18.
    Heart Protection Study Collaborative, G. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360(9326):7–22.Google Scholar
  19. 19.
    Poredos P, Jezovnik MK. Antiplatelet and antithrombotic treatment of patients with peripheral arterial disease. Int Angiol. 2010;29(1):20–6.PubMedGoogle Scholar
  20. 20.
    El Sakka K, et al. Association of malignant disease with critical leg ischaemia. Br J Surg. 2005;92(12):1498–501.CrossRefPubMedGoogle Scholar
  21. 21.
    Norgren L, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl S):S5–67.CrossRefGoogle Scholar
  22. 22.
    Fowkes FG, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329–40.CrossRefGoogle Scholar
  23. 23.
    Fowler B, et al. Improving maximum walking distance in early peripheral arterial disease: randomised controlled trial. Aust J Physiother. 2002;48(4):269–75.CrossRefPubMedGoogle Scholar
  24. 24.
    Hankey GJ, Norman PE, Eikelboom JW. Medical treatment of peripheral arterial disease. JAMA. 2006;295(5):547–53.CrossRefPubMedGoogle Scholar
  25. 25.
    Rooke TW, et al. 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2011;58(19):2020–45.CrossRefPubMedGoogle Scholar
  26. 26.
    Klinkert P, et al. Vein versus polytetrafluoroethylene in above-knee femoropopliteal bypass grafting: five-year results of a randomized controlled trial. J Vasc Surg. 2003;37(1):149–55.CrossRefPubMedGoogle Scholar
  27. 27.
    Indes JE, et al. Clinical outcomes of 5358 patients undergoing direct open bypass or endovascular treatment for aortoiliac occlusive disease: a systematic review and meta-analysis. J Endovasc Ther. 2013;20(4):443–55.CrossRefPubMedGoogle Scholar
  28. 28.
    Conte MS, et al. Results of PREVENT III: a multicenter, randomized trial of edifoligide for the prevention of vein graft failure in lower extremity bypass surgery. J Vasc Surg. 2006;43(4):742–751; discussion 751.Google Scholar
  29. 29.
    Adam DJ, et al. Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet. 2005;366(9501):1925–34.CrossRefGoogle Scholar
  30. 30.
    Aggarwal V, Waldo SW, Armstrong EJ. Endovascular revascularization for aortoiliac atherosclerotic disease. Vasc Health Risk Manag. 2016;12:117–27.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Dake MD, et al. Nitinol stents with polymer-free paclitaxel coating for lesions in the superficial femoral and popliteal arteries above the knee: twelve-month safety and effectiveness results from the Zilver PTX single-arm clinical study. J Endovasc Ther. 2011;18(5):613–23.CrossRefPubMedGoogle Scholar
  32. 32.
    Tran K, et al. Real-world performance of paclitaxel drug-eluting bare metal stenting (Zilver PTX) for the treatment of femoropopliteal occlusive disease. Ann Vasc Surg. 2017;38:90–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Candy N, Ng E, Velu R. Paclitaxel-coated balloon reduces target lesion revascularization compared with standard balloon angioplasty. J Vasc Surg. 2017;65(2):558–70. e10CrossRefPubMedGoogle Scholar
  34. 34.
    Laird JR, et al. Durability of treatment effect using a drug-coated balloon for femoropopliteal lesions: 24-month results of IN.PACT SFA. J Am Coll Cardiol. 2015;66(21):2329–38.CrossRefPubMedGoogle Scholar
  35. 35.
    Duda SH, et al. Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial. J Endovasc Ther. 2006;13(6):701–10.CrossRefPubMedGoogle Scholar
  36. 36.
    Hajibandeh S, et al. Covered vs uncovered stents for aortoiliac and femoropopliteal arterial disease: a systematic review and meta-analysis. J Endovasc Ther. 2016;23(3):442–52.CrossRefPubMedGoogle Scholar
  37. 37.
    Mwipatayi BP, et al. Durability of the balloon-expandable covered versus bare-metal stents in the Covered versus Balloon Expandable Stent Trial (COBEST) for the treatment of aortoiliac occlusive disease. J Vasc Surg. 2016;64(1):83–94. e1CrossRefPubMedGoogle Scholar
  38. 38.
    McQuade K, et al., Four-year randomized prospective comparison of percutaneous ePTFE/nitinol self-expanding stent graft versus prosthetic femoral-popliteal bypass in the treatment of superficial femoral artery occlusive disease. J Vasc Surg. 2010;52(3):584–90; discussion 590–1, 591 e1–591 e7.CrossRefGoogle Scholar
  39. 39.
    Geraghty PJ, et al. Three-year results of the VIBRANT trial of VIABAHN endoprosthesis versus bare nitinol stent implantation for complex superficial femoral artery occlusive disease. J Vasc Surg. 2013;58(2):386–95. e4CrossRefPubMedGoogle Scholar
  40. 40.
    Modrall JG, Sadjadi J. Early and late presentations of radiation arteritis. Semin Vasc Surg. 2003;16(3):209–14.CrossRefPubMedGoogle Scholar
  41. 41.
    Baerlocher MO, et al. Primary stenting of bilateral radiation-induced external iliac stenoses. J Vasc Surg. 2004;40(5):1028–31.CrossRefPubMedGoogle Scholar
  42. 42.
    Moutardier V, et al. Iliac atherosclerotic occlusive disease complicating radiation therapy for cervix cancer: a case series. Gynecol Oncol. 2002;84(3):456–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Haddad TC, Greeno EW. Chemotherapy-induced thrombosis. Thromb Res. 2006;118(5):555–68.CrossRefPubMedGoogle Scholar
  44. 44.
    Fernandes DD, et al. Acute aortic thrombosis in patients receiving cisplatin-based chemotherapy. Curr Oncol. 2011;18(2):e97–100.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Schutz FA, et al. Bevacizumab increases the risk of arterial ischemia: a large study in cancer patients with a focus on different subgroup outcomes. Ann Oncol. 2011;22(6):1404–12.CrossRefPubMedGoogle Scholar
  46. 46.
    Alhawiti N, et al. The tyrosine kinase inhibitor, nilotinib potentiates a prothrombotic state. Thromb Res. 2016;145:54–64.CrossRefPubMedGoogle Scholar
  47. 47.
    Lang K, et al. Mortality and vascular events among elderly patients with chronic myeloid leukemia: a retrospective analysis of linked SEER-Medicare Data. Clin Lymphoma Myeloma Leuk. 2016;16(5):275–285.e1.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Tam T. T. Huynh
    • 1
    • 2
    Email author
  • Hue T. Cao
    • 1
  • Susana G. Palma
    • 3
  • Karen C. Broadbent
    • 3
  1. 1.Department of Thoracic and Cardiovascular SurgeryThe University of Texas – MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Interventional RadiologyThe University of Texas – MD Anderson Cancer CenterHoustonUSA
  3. 3.Thoracic and Orthopedic CenterThe University of Texas – MD Anderson Cancer CenterHoustonUSA

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