Wei KC, Yang KC, Mar GY, Chen LW, Wu CS, Lai CC, Wang WH, Lai PC, et al.
Medicine. Date of publication 2015 Dec 1;volume 94(48):e2178.
1. Medicine (Baltimore). 2015 Dec;94(48):e2178. doi: 10.1097/MD.0000000000002178.
STROBE--Radiation Ulcer: An Overlooked Complication of Fluoroscopic Intervention:
A Cross-Sectional Study.
Wei KC(1), Yang KC, Mar GY, Chen LW, Wu CS, Lai CC, Wang WH, Lai PC.
Author information:
(1)From the Department of Dermatology (K-CW, C-SW) and Department of Plastic and
Reconstructive Surgery (K-CY, L-WC), Kaohsiung Veterans General Hospital,
Kaohsiung, Taiwan; Faculty of Yuhing Junior College of Health Care and
Management, Kaohsiung, Taiwan (K-CW); Department of Cardiology, Kaohsiung
Veterans General Hospital, Kaohsiung, Taiwan (G-YM, C-CL, W-HW); National
Yang-Ming University School of Medicine, Taipei, Taiwan (L-WC); and Department of
Nephrology, Kidney Center, Chang Gung Memorial Hospital, Chang Gung School of
Medicine, Chang Gung University, Linkou, Taiwan (P-CL).
With increasing numbers of percutaneous coronary intervention (PCI) and complex
cardiac procedures, higher accumulated radiation dose in patient has been
observed. We speculate cardiac catheter intervention induced radiation skin
damage is no longer rare.To study the incidence of cardiac fluoroscopic
intervention induced radiation ulcer. We retrospectively reviewed medical records
of those who received cardiac fluoroscopic intervention in our hospital during
2012 to 2013 for any events of radiation ulcer. Only patients, whose clinical
photos were available for reviewing, would be included for further evaluation.
The diagnosis of radiation ulcers were made when there is a history of PCI with
pictures proven skin ulcers, which presented typical characteristics of radiation
injury. Nine patients with radiation ulcer were identified and the incidence was
0.34% (9/2570) per practice and 0.42% (9/2124) per patient. Prolonged procedure
time, cumulative multiple procedures, right coronary artery occlusion with
chronic total occlusion, obesity, and diabetes are frequent characteristics. The
onset interval between the first skin manifestation and the latest radiation
exposure varied from 3 weeks to 3 months. The histopathology studies failed to
make diagnosis correctly in 5 out of 6 patients. To make thing worse, skin biopsy
exacerbated the preexisting radiation dermatitis. Notably, all radiation ulcers
were refractory to conventional wound care. Surgical intervention was necessary
to heal the wound. Diagnosis of cardiac fluoroscopy intervention induced
radiation skin damage is challenging and needs high index of clinical suspicion.
Minimizing the radiation exposure by using new approaches is the most important
way to prevent this complication. Patient education and a routine postprocedure
dermatology follow up are mandatory in high-risk groups for both radiation skin
damage and malignancies. This is a retrospective study, thus the true incidence
of radiation ulcer caused by cardiac fluoroscopic intervention could be higher.
DOI: 10.1097/MD.0000000000002178
PMCID: PMC4674206
PMID: 26632903 [Indexed for MEDLINE]
