Radiation-induced skin injury after complex endovascular procedures

Modern vascular surgeons perform an ever-increasing number of complex endovascular procedures, largely based on patient preference, decreased length of stay, and improved outcome. With the upsurge of endovascular cases, concern has grown regarding the harmful effects of radiation exposure delivered to the patient and the operator. Surgeon education on the appropriate use of fluoroscopic operating factors coupled with appropriate training in radiation safety has been shown to decrease radiation dose. This review elucidates dose terminology and metrics, possible radiation-induced injuries, risk factors for deterministic injury, and radiation safety principles and techniques. Tables provide practical tips to lower patient and operator radiation dose during fluoroscopically guided intervention, and National Council on Radiation Protection & Measurements recommended dose limits for occupational exposure. Figures illustrate reference air kerma, radiation-induced skin injury, effects of image receptor and table position, and operator exposure. This review contains 4 figures, 3 tables, and 53 references.

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Will mesenchymal stem cells be future directions for treating radiation-induced skin injury?

Stem Cell Research & Therapy ◽

10.1186/s13287-021-02261-5 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Zhuoqun Fang ◽

Penghong Chen ◽

Shijie Tang ◽

Aizhen Chen ◽

Chaoyu Zhang ◽

...

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Malignant Tumors ◽

Skin Injury ◽

Future Directions ◽

Cytokines And Chemokines ◽

Radiation Induced ◽

The Common ◽

Apoptotic Activity ◽

Different Sources

AbstractRadiation-induced skin injury (RISI) is one of the common serious side effects of radiotherapy (RT) for patients with malignant tumors. Mesenchymal stem cells (MSCs) are applied to RISI repair in some clinical cases series except some traditional options. Though direct replacement of damaged cells may be achieved through differentiation capacity of MSCs, more recent data indicate that various cytokines and chemokines secreted by MSCs are involved in synergetic therapy of RISI by anti-inflammatory, immunomodulation, antioxidant, revascularization, and anti-apoptotic activity. In this paper, we not only discussed different sources of MSCs on the treatment of RISI both in preclinical studies and clinical trials, but also summarized the applications and mechanisms of MSCs in other related regenerative fields.

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A novel role for bone marrow-derived cells to recover damaged keratinocytes from radiation-induced injury

Scientific Reports ◽

10.1038/s41598-021-84818-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Junko Okano ◽

Yuki Nakae ◽

Takahiko Nakagawa ◽

Miwako Katagi ◽

Tomoya Terashima ◽

...

Keyword(s):

Bone Marrow ◽

Underlying Mechanism ◽

Basal Cells ◽

Barrier Dysfunction ◽

Skin Injury ◽

Accelerated Proliferation ◽

Radiation Induced ◽

Bone Marrow Derived Cells ◽

Injury Recovery

AbstractExposure to moderate doses of ionizing radiation (IR), which is sufficient for causing skin injury, can occur during radiation therapy as well as in radiation accidents. Radiation-induced skin injury occasionally recovers, although its underlying mechanism remains unclear. Moderate-dose IR is frequently utilized for bone marrow transplantation in mice; therefore, this mouse model can help understand the mechanism. We had previously reported that bone marrow-derived cells (BMDCs) migrate to the epidermis-dermis junction in response to IR, although their role remains unknown. Here, we investigated the role of BMDCs in radiation-induced skin injury in BMT mice and observed that BMDCs contributed to skin recovery after IR-induced barrier dysfunction. One of the important mechanisms involved the action of CCL17 secreted by BMDCs on irradiated basal cells, leading to accelerated proliferation and recovery of apoptosis caused by IR. Our findings suggest that BMDCs are key players in IR-induced skin injury recovery.

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Sulforaphane-Mediated Nrf2 Activation Prevents Radiation-Induced Skin Injury through Inhibiting the Oxidative-Stress-Activated DNA Damage and NLRP3 Inflammasome

Antioxidants ◽

10.3390/antiox10111850 ◽

2021 ◽

Vol 10 (11) ◽

pp. 1850

Author(s):

Jinlong Wei ◽

Qin Zhao ◽

Yuyu Zhang ◽

Weiyan Shi ◽

Huanhuan Wang ◽

...

Keyword(s):

Oxidative Stress ◽

Dna Damage ◽

Western Blotting ◽

Nlrp3 Inflammasome ◽

Fibrous Tissue ◽

Mouse Skin ◽

Control Group ◽

Skin Injury ◽

Antioxidant Genes ◽

Radiation Induced

This article mainly observed the protective effect of sulforaphane (SFN) on radiation-induced skin injury (RISI). In addition, we will discuss the mechanism of SFN’s protection on RISI. The RISI model was established by the irradiation of the left thigh under intravenous anesthesia. Thirty-two C57/BL6 mice were randomly divided into control group (CON), SFN group, irradiation (IR) group, and IR plus SFN (IR/SFN) group. At eight weeks after irradiation, the morphological changes of mouse skin tissues were detected by H&E staining. Then, the oxidative stress and inflammatory response indexes in mouse skin tissues, as well as the expression of Nrf2 and its downstream antioxidant genes, were evaluated by ELISA, real-time PCR, and Western blotting. The H&E staining showed the hyperplasia of fibrous tissue in the mouse dermis and hypodermis of the IR group. Western blotting and ELISA results showed that the inflammasome of NLRP3, caspase-1, and IL-1β, as well as oxidative stress damage indicators ROS, 4-HNE, and 3-NT, in the skin tissues of mice in the IR group were significantly higher than those in the control group (p < 0.05). However, the above pathological changes declined sharply after SFN treatment (p < 0.05). In addition, the expressions of Nrf2 and its regulated antioxidant enzymes, including CAT and HO-1, were higher in the skin tissues of SFN and IR/SFN groups, but lower in the control and IR groups (p < 0.05). SFN may be able to suppress the oxidative stress by upregulating the expression and function of Nrf2, and subsequently inhibiting the activation of NLRP3 inflammasome and DNA damage, so as to prevent and alleviate the RISI.

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Ulcerated Radiodermatitis Induced after Fluoroscopically Guided Stent Implantation Angioplasty

Case Reports in Dermatological Medicine ◽

10.1155/2014/768624 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Maira Elizabeth Herz-Ruelas ◽

Minerva Gómez-Flores ◽

Joaquín Moxica-del Angel ◽

Ivett Miranda-Maldonado ◽

Ilse Marilú Gutiérrez-Villarreal ◽

...

Keyword(s):

Stent Implantation ◽

Radiation Dermatitis ◽

Skin Injury ◽

Chronic Radiation ◽

Severe Coronary Artery ◽

Radiation Induced ◽

Artery Disease ◽

Left Scapula ◽

Skin Plaque

Cases of radiation-induced skin injury after fluoroscopically guided procedures have been reported since 1996, though the majority of them have been published in Radiology and Cardiology literature, less frequently in Dermatology journals. Chronic radiation dermatitis induced by fluoroscopy can be difficult to diagnose; a high grade of suspicion is required. We report a case of an obese 46-year-old man with hypertension, dyslipidemia, and severe coronary artery disease. He developed a pruritic and painful atrophic ulcerated skin plaque over his left scapula, six months after fluoroscopically guided stent implantation angioplasty. The diagnosis of radiodermatitis was confirmed histologically. We report this case to emphasize the importance of recognizing fluoroscopy as a cause of radiation dermatitis. A good clinical follow-up at regular intervals is important after long and complicated procedures, since the most prevalent factor for injury is long exposure time.

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Amelioration of radiation-induced skin injury by adenovirus-mediated heme oxygenase-1 (HO-1) overexpression in rats

Radiation Oncology ◽

10.1186/1748-717x-7-4 ◽

2012 ◽

Vol 7 (1) ◽

pp. 4 ◽

Cited By ~ 14

Author(s):

Shuyu Zhang ◽

Chuanjun Song ◽

Jundong Zhou ◽

Ling Xie ◽

Xingjun Meng ◽

...

Keyword(s):

Heme Oxygenase ◽

Heme Oxygenase 1 ◽

Skin Injury ◽

Radiation Induced

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The healing effect of hydrogen-rich water on acute radiation-induced skin injury in rats

Journal of Radiation Research ◽

10.1093/jrr/rry074 ◽

2018 ◽

Vol 60 (1) ◽

pp. 17-22 ◽

Cited By ~ 6

Author(s):

Ping Zhou ◽

Bing Lin ◽

Peng Wang ◽

Tao Pan ◽

Shun Wang ◽

...

Keyword(s):

Acute Radiation ◽

Skin Injury ◽

Healing Effect ◽

Radiation Induced

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Persea americana Mill. crude extract exhibits antinociceptive effect on UVB radiation-induced skin injury in mice

Inflammopharmacology ◽

10.1007/s10787-018-0441-9 ◽

2018 ◽

Vol 27 (2) ◽

pp. 323-338

Author(s):

Viviane C. K. N. Deuschle ◽

Indiara Brusco ◽

Mariana Piana ◽

Henrique Faccin ◽

Leandro Machado de Carvalho ◽

...

Keyword(s):

Crude Extract ◽

Antinociceptive Effect ◽

Persea Americana ◽

Uvb Radiation ◽

Skin Injury ◽

Radiation Induced

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Radiation-Induced Alopecia after Endovascular Embolization under Fluoroscopy

Case Reports in Dermatological Medicine ◽

10.1155/2016/8202469 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5

Author(s):

Vipawee Ounsakul ◽

Wimolsiri Iamsumang ◽

Poonkiat Suchonwanit

Keyword(s):

Cerebral Angiography ◽

Endovascular Procedures ◽

Endovascular Embolization ◽

Target Pattern ◽

Geometric Shapes ◽

Radiation Induced

Radiation-induced alopecia after fluoroscopically guided procedures is becoming more common due to an increasing use of endovascular procedures. It is characterized by geometric shapes of nonscarring alopecia related to the area of radiation. We report a case of a 46-year-old man presenting with asymptomatic, sharply demarcated rectangular, nonscarring alopecic patch on the occipital scalp following cerebral angiography with fistula embolization under fluoroscopy. His presentations were compatible with radiation-induced alopecia. Herein, we also report a novel scalp dermoscopic finding of blue-grey dots in a target pattern around yellow dots and follicles, which we detected in the lesion of radiation-induced alopecia.

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