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Chronic radiodermatitis following repeated percutaneous transluminal coronary angioplasty
T Kawakami1, R Saito, S Miyazaki
1Second Department of Dermatology, Toho University School of Medicine, 2-17-6, Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
Insights
Chronic radiodermatitis can occur after multiple coronary angioplasties in patients with ischemic heart disease. This skin condition presents as atrophic plaques, highlighting radiation injury risks in repeated cardiac catheterizations.
Area of Science:
- Cardiology
- Dermatology
- Radiation Oncology
Background:
- Patients with chronic ischemic heart disease (IHD) often undergo multiple percutaneous transluminal coronary angioplasties (PTCAs).
- While generally safe, cardiac catheterization procedures carry a risk of radiation-induced injury.
- The cumulative effects of repeated radiation exposure in high-risk patient groups warrant attention.
Observation:
- Three patients developed chronic radiodermatitis on their upper back after multiple PTCAs.
- The skin lesions were characterized by atrophic rectangular plaques with mottled hyper/hypopigmentation and reticulate telangiectasia.
- Histological examination revealed epidermal atrophy, dermal collagen changes, and superficial vessel telangiectasia.
Findings:
- The observed radiodermatitis is a consequence of cumulative radiation exposure during repeated PTCA procedures.
- Histopathological findings confirm radiation injury to the skin, including epidermal and dermal changes.
- The risk is elevated in patients with long-standing IHD undergoing numerous catheterizations for limited coronary artery disease.
Implications:
- Healthcare providers should be aware of the potential for chronic radiodermatitis in patients undergoing frequent cardiac catheterizations.
- Identifying high-risk patients, such as those with IHD and multiple PTCAs, is crucial for preventative strategies.
- Further research into radiation dose management and protective measures during interventional cardiology procedures is recommended.
Abstract:
We review three patients who developed chronic radiodermatitis subsequent to undergoing multiple percutaneous transluminal coronary angioplasties (PTCAs). All patients had had chronic ischaemic heart disease (IHD) and had undergone lengthy PTCA on several occasions. The skin eruption was characterized by an atrophic rectangular plaque on the left upper back, presenting as mottled hyper- and hypopigmentation with reticulate telangiectasia. Histologically, the eruption demonstrated epidermal atrophy, hyalinized and irregularly stained collagen, and telangiectasia of superficial vessels in the dermis. Although the risk of radiation injury in most patients undergoing cardiac catheterization is low, this danger should not be ignored. In particular, patients with long-standing IHD and numerous repeated catheterizations to only one or two occluded coronary arteries should be considered at high risk.