[Radiodermatitis after transjugular intrahepatic portosystemic shunt: 4 cases]

Radiodermatitis following invasive radiographic procedures has been reported recently in the literature, mainly after cardiac catheterization. Only two publications are related to transjugular intrahepatic portosystemic shunt (TIPS), a recently introduced angiographic technique for achieving portal decompression.

We report four cases of radiodermatitis following a transjugular intrahepatic portosystemic shunt. A 63-year-old woman developed in 1997 a chronic radiodermatitis under the right scapula; a shunt was placed in 1992; from 1992 to 1997, she had a second transjugular intrahepatic portosystemic shunt and thereafter four dilatations. A 50-year-old man developed in 1994 a radio-induced ulceration in the same area, one week after a transjugular intrahepatic portosystemic shunt; the same year the shunt was expanded. The patient had a second transjugular intrahepatic portosystemic shunt in 1995; at that time, the cutaneous lesions evolved into chronic radiodermatitis. In 1995 a 67-year-old man developed chronic radiodermatitis under the right scapula; a transjugular intrahepatic portosystemic shunt was placed in 1992; endoprosthesis was dilated four times from 1992 to 1995. A 82-year-old women developed in 1993 an ulcerated radiodermatitis, five days after a transjugular intrahepatic portosystemic shunt.

The major advantage of the transjugular intrahepatic portosystemic shunt is the ability to provide portosystemic decompression without major surgery. However, radiation exposure during the procedure is sometimes very high. Otherwise the prosthesis is readily blocked up; this side-effect requires repeated angiographic dilatations. The procedures were very long by all our patients. This explains the high absorbed radiation doses. Transjugular intrahepatic portosystemic shunt and cardiac catheterization are not the only procedures at risk. A lot of invasive radiographic techniques can result in high radiation exposure and hence radiodermatitis.