[Secondary radiodermatitis caused by endovascular explorations: 5 cases]

Abstract

Background: Fluoroscopically guided interventional procedures expose patients to high doses of ionizing radiation.

Observations: We describe 5 patients in whom radiodermatitis developed following vascular catheterization: cardiac catheterization and coronary angioplasty in 4 cases and renal artery catheterization and angioplasty in 1 case. All patients were men. The endovascular procedures have been repeated or prolonged in all cases excepted one. The clinical aspects were those of a chronic radiodermatitis (4 cases) and acute radiodermatitis (1 case). An extensive and painful ulceration was observed in 3 patients for which surgical excision was proposed. In one case lesions were bilateral. Delay of onset after the last exploration varied from a few weeks to 3 years. Biopsy specimen was suggestive of chronic radiodermatitis but, in 2 cases, was not contributive in the absence of clinical proposal.

Discussion: About 20 cases of radiodermatitis following coronary angioplasty have been reported in the literature since 1996. The cumulative radiation doses to which the patients were exposed are compatible with the occurrence of radiodermatitis. Coronary angiography using fluoroscopy and cineradiography delivers notably higher radiation doses than any other routine procedure. Even higher levels of radiation may result from percutaneous transluminal angioplasty, which is a more complicated and lengthier procedure frequently repeated. Radiodermatitis have been described during many other vascular procedures like radiofrequency catheter ablation, renal angioplasty, interventional neuroradiologic and hepato-biliary procedures. Medical facilities and physicians performing interventional procedures should be aware of these sides effects and implement measures to reduce the potential for radiation skin injuries.