Cutaneous complications of hepatic chemoembolization via extrahepatic collaterals

PURPOSE: To report cutaneous complications occurring after chemoembolizatio n of hepatic tumors via extrahepatic collaterals. METHODS: Five patients underwent chemoembolization via the internal mammary (n = 3), intercostal (n = 1), or multiple extrahepatic collateral vessels supplying liver metastases. RESULTS: Painful induration and discoloration of the skin in the distributi on of the superior epigastric or intercostal arteries occurred in four pati ents, with transmural necrosis in two, One required surgical excision, One patient developed a radiation burn after 12 procedures and eventually devel oped a squamous cell carcinoma at the site, which required resection and sk in grafting. CONCLUSION: Cutaneous injury can occur after chemoembolization of extrahepa tic collaterals. Scrupulous technique is required to avoid nontarget emboli zation of chemotherapeutic drugs. High cumulative radiation doses to locali zed areas of skin can occur in patients undergoing multiple procedures.