Endovascular Infrarenal Aortic Aneurysm Repair Performed in a Hybrid Operating Room Versus Conventional Operating Room Using a C-Arm

Radiation Exposure and Contrast Agent Use during Endovascular Aortic Repair Using Mobile Versus Fixed Angiography Systems

“…To date, several studies have reported on experience with radiation exposure during standard, uncomplicated EVAR procedures. In this regard, Martinez et al reported a higher radiation exposure during EVAR in the HOR using fixed angiographic equipment compared to the HOR [ 13 ]. Similar to that result, Schaefers et al described in their cohort of 160 patients a lower radiation exposure when using a mobile C-arm angiography system in standard EVAR procedures [ 15 ].…”

“…In addition, anatomical landmarks such as neck angulation, AAA diameter, neck diameter, and type of AAA may affect radiation exposure levels [ 24 ]. For instance, such hostile anatomical configurations may require longer fluoroscopy times because they are technically more complex; however, such considerations may be challenged by other studies that have reported no difference in radiation exposure during EVAR procedures in patient cohorts with different neck lengths in emergency versus elective settings [ 13 ]. In this regard, factors other than anatomical landmarks, such as the choice of stent graft and the application of fusion imaging techniques, may contribute even more to the radiation dose level than the choice of fixed versus mobile angiography systems themselves.…”

“…For the elective treatment of aortic pathologies using (T)EVAR both mobile C-arms in the standard operating room (SOR) and fixed C-arm angiography systems in the hybrid operating room (HOR) are available. Debates have persisted regarding whether fixed C-arm systems offer lower radiation and contrast agent doses with superior image quality, although some studies have indicated that mobile C-arms significantly reduce radiation exposure in EVAR [ 12 , 13 , 14 , 15 ].…”

“…In addition, hardware-based supplemental strategies can reduce radiation exposure even further while simultaneously improving imaging quality in the HOR [ 14 ]. Similar concepts addressing the same issue have also been introduced in the SOR, suggesting that performing EVAR from an ionizing radiation perspective could be a safer method [ 13 , 15 ]. In addition, alternative contrast agents, such as carbon dioxide (CO 2 ) and gadolinium, have also been introduced; however, these agents remain limited to specialized centers and selective cases [ 16 , 19 ].…”

Fixed compared to mobile imaging arms for transcarotid artery revascularization

“…Previous studies have demonstrated that both infrarenal and fenestrated endovascular aortic aneurysm repair (EVAR) can be performed in either setting with minimal disadvantages, except for radiation dosage. 8,9 Though it is important to consider that imaging through the head and neck is associated with much lower levels of radiation compared to the trunk. A different investigation showed that lower-limb revascularization has equivalent technical success using either fixed or mobile modalities.…”