Radiodermatitis after transjugular intrahepatic portosystemic shunt: 4 cases.

Background, Radiodermatitis following invasive radiographic procedures has been reported recently in the literature, mainly after cardiac catheterizat ion. Only two publications are related to transjugular intrahepatic portosy stemic shunt (TIPS), a recently introduced angiographic technique for achie ving portal decompression. Case reports, We report four cases of radiodermatitis following a transjugu lar intrahepatic portosystemic shunt. A 63-year-old woman developed in 1997 a chronic radiodermatitis under the right scapula; a shunt was placed in 1 992; from 1992 to 1997, she had a second transjugular intrahepatic portosys temic 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 transju gular intrahepatic portosystemic shunt; the same year the shunt was expande d. The patient had a second transjugular intrahepatic portosystemic shunt i n 1995; at that time, the cutaneous lesions evolved into chronic radioderma titis. In 1995 a 67-year-old man developed chronic radiodermatitis under th e right scapula; a transjugular intrahepatic portosystemic shunt was placed in 1992; endoprosthesis was dilated four rimes from 1992 to 1995. A 82-yea r-old women developed in 1993 an ulcerated radiodermatitis, five days after a transjugular intrahepatic portosystemic shunt. Discussion. The major advantage of the transjugular intrahepatic portosyste mic shunt is the ability to provide portosystemic decompression without maj or surgery. However, radiation exposure during the procedure is sometimes v ery high. Otherwise the prosthesis is readily blocked up; this side-effect requires repeated angiographic dilatations. The procedures were very long b y all our patients. This explains the high absorbed radiation doses. Transj ugular 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.