[Management by the angiologist of sequellae of radiosurgical treatment of breast cancer].

Often called in to give his opinion on lymphoedema of the upper limb after radiosurgical treatment for breast cancer, the angiologist should be familiar with the anatomic lesions induced by the treatment. The surgical procedure varies from simple tumourectomy to complete mammectomy. Complications include infection followed by fibrosis and occlusion of the collecting lymphatic vessels. Axillary venous thrombosis is exceptional. Dissection of the lymph nodes interrupts lymph drainage of the homolateral limb leading to lymphoedema which is worsened by fibrosis, venous stasis and damage to the plexus. Ionization therapy causes multiple organ damage to viscera (lungs, pleura), skeleton (ribs, clavicle), myocardium and coronary arteries, mediastinal brachial plexus, skin fibrosis, arterial obliteration and venous narrowing and thrombosis. Chemotherapy causes thrombosis of the superficial veins after perfusion. Deep vein thrombosis is rare. These lesions rarely occur alone. The clinical course of the associated lesions is part of a major psychological context which must be taken into account. The angiologist should perform a careful clinical examination, detect and document possible recurrence, explore the vascular axes with echo-Doppler or plethysmography when needed in order to detect the venous lesions which occur in 50% of the cases. Lymphatic involvement in lymphoedema is clinically obvious and may not require further explorations. Treatment is difficult in cases with associated venous involvement. Strapping with or without pressure, manual lymphatic drainage, active mobilisation and elastic sleave after reduction are used. When detected early venous thrombosis is managed as other deep vein thrombosis. Arterial damage may appear late (delay more than 3 years) in rare cases.(ABSTRACT TRUNCATED AT 250 WORDS)