Radiation exposure in endovascular infra-renal aortic aneurysm repair and factors that influence it

Abstract

ObjectiveThe endovascular repair of aortic abdominal aneurysms exposes the patients and surgical team to ionizing radiation with risk of direct tissue damage and induction of gene mutation. This study aims to describe our standard of radiation exposure in endovascular aortic aneurysm repair and the factors that influence it.MethodsRetrospective analysis of a prospective database of patients with abdominal infra-renal aortic aneurysms submitted to endovascular repair. This study evaluated the radiation doses (dose area product (DAP)), fluoroscopy durations and their relationships to the patients, aneurysms, and stent-graft characteristics.ResultsThis study included 127 patients with a mean age of 73 years. The mean DAP was 4.8 mGy.m2, and the fluoroscopy time was 21.8 minutes. Aortic bilateral iliac aneurysms, higher body mass index, aneurysms with diameters larger than 60 mm, necks with diameters larger than 28 mm, common iliac arteries with diameters larger than 20 mm, and neck angulations superior to 50 degrees were associated with an increased radiation dose. The number of anatomic risk factors present was associated with increased radiation exposure and fluoroscopy time, regardless of the anatomical risk factors.ConclusionThe radiation exposure during endovascular aortic aneurysm repair is significant (mean DAP 4.8 mGy.m2) with potential hazards to the surgical team and the patients. The anatomical characteristics of the aneurysm, patient characteristics, and the procedure's technical difficulty were all related to increased radiation exposure during endovascular aortic aneurysm repair procedures. Approximately 40% of radiation exposure can be explained by body mass index, neck angulation, aneurysm diameter, neck diameter, and aneurysm type.

Radiation exposure in an endovascular aortic aneurysm repair program after introduction of a hybrid operating theater

“…In total, 12 studies representing 1264 patients were included. 22,[24][25][26][27][28][29][30][31][32][33][34] Of the 10 studies with a fixed system, 12 mean and 13 median values of the DAP were present. Of the 12 studies using a mobile system, 9 mean and 10 median values of the DAP were present.…”

A Simple Target Will Save the Day and the Kidney: This Is How We Perform Our Endovascular Fenestrated Graft Procedure

“…Two-vessel FEVAR had an average fluoroscopy time of 63 minutes, and three or four-vessel procedures had a fluoroscopy time of 89 minutes [ 18 ]. Compared to traditional endovascular aortic repair (EVAR), cases had three to four times less fluoroscopy time with an average of 21.8 minutes [ 19 ]. The amount of radiation exposure would only increase in a difficult FEVAR case with inaccessible renal arteries.…”

<p>The Nellix endovascular aneurysm sealing system: current perspectives</p>

“…Radiation exposure during EVAR poses a potential hazard toward patient safety 29,30. EVAS may have a benefit by exposing patients to less radiation compared to EVAR.…”