Radiation Dose Reduction During EVAR: Results from a Prospective Multicentre Study (The REVAR Study)

Hertault, Adrien; Rhee, Robert Y.; Antoniou, George Α.; Adam, Donald J.; Tonda, Hisashi; Rousseau, Hervé; Bianchini, Aurélia; Haulon, Stéphan

doi:10.1016/j.ejvs.2018.05.001

Cited by 45 publications

(23 citation statements)

References 24 publications

(18 reference statements)

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“…If utilization of lead glasses had also been neglected, the annual equivalent dose limit for the eyes would have been reached with just one PAE procedure per week. Taken together, all these data emphasize the need for careful and systematic application of the ALARA principle in the clinical context of PAE; strict adherence to the ALARA concept in other complex endovascular procedures has resulted in dramatic reduction of radiation exposure (Hertault et al 2018). In selected patients, the herein proposed reduction of steep oblique views during PAE appears to be a feasible step towards the implementation of this principle.…”

Section: Discussionmentioning

confidence: 75%

Prostatic artery embolization performed in anteroposterior projections versus steep oblique projections: single centre retrospective comparative analysis

et al. 2021

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Background To present and evaluate an approach for reduction of utilization of steep oblique angiographic projections during prostatic artery embolization (PAE). Methods Single-center, retrospective study of patients who underwent bilateral PAE (from October 2018 to November 2019) and in whom it was possible to embolize PA of at least one pelvic side utilizing anteroposterior projections only (AP-PAE group), with the following techniques: Identification of the origin of PA on anteroposterior angiographic views. Utilization of anatomic landmarks from the planning computed tomographic angiography. Distal advancement of the angiographic catheter or microcatheter in the anterior division of internal iliac artery. Gentle probing with microguidewire at the expected site of origin of the PA. The AP-PAE approach was initially applied to all PAE patients during the study period and when this approach failed, additional steep oblique projections were acquired; patients who underwent bilateral PAE, with both anteroposterior and oblique projections for both pelvic sides, formed the standard PAE (S-PAE) group. The AP-PAE group was compared with S-PAE group in terms of baseline clinical and anatomic features, technical/procedural aspects and outcomes. Results Forty-six patients (92 pelvic sides) were studied. AP-PAE was feasible in 12/46 patients (26.0%): unilateral AP-PAE in 9/46 patients (19.5%); bilateral AP-PAE in 3/46 patients (6.5%). AP-PAE group had larger prostates (p = 0.047) and larger PAs (p < 0.001). Body mass index (BMI) and other baseline features were comparable between the two groups (mean BMI, AP-PAE group: 27.9 ± 3.6, S-PAE group: 27.0 ± 3.5, p = 0.451). Mean fluoroscopy time and dose area product were lower in AP-PAE group (46.3 vs 57.9 min, p = 0.084 and 22,924.9 vs 35,800.4 μGy.m2, p = 0.018, respectively). Three months post PAE, comparable clinical success rates (11/12 vs 31/34, p = 0.959) and mean International Prostate Symptom Score reduction (60.2% vs 58.1%, p = 0.740) were observed for AP-PAE and for S-PAE group, respectively. No major complications were encountered. Conclusion AP-PAE is associated with significant reduction in radiation exposure and appears to be feasible, safe and effective, but it can be applied in a relatively small percentage of patients.

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Section: Discussionmentioning

confidence: 75%

Prostatic artery embolization performed in anteroposterior projections versus steep oblique projections: single centre retrospective comparative analysis

et al. 2021

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“…Recent studies concluded that the number of prostatic arteries origins and anastomoses that could be identi ed were signi cantly higher with CBCT than with DSA [11], and that CBCT provided essential information that was not available with DSA in 46% [12] to 60.8% [11] of patients. Finally, advanced imaging techniques such as 3D road-mapping should be utilized as they can contribute to both performing safer and more e cient procedures, and reducing x-ray dose and procedure time [33,34].…”

Section: Imaging Optionsmentioning

confidence: 99%

Advanced Image Guidance For Prostatic Artery Embolization – A Multicenter Technical Note

Carnevale

McClure

Cadour

et al. 2021

Preprint

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Prostatic artery embolization (PAE) is associated with patients’ quality of life improvements and limited side effects compared to surgery. However, this procedure remains technically challenging due to complex vasculature, anatomical variations and small arteries, inducing long procedure times and high radiation exposure levels both to patients and medical staff. Moreover, the risk of non-target embolization can lead to relevant complications. In this context, advanced imaging can constitute a solid ally to address these challenges and deliver good clinical outcomes at acceptable radiation levels. This technical note aims to share the consolidated experience of four institutions detailing their optimized workflow using advanced image guidance, discussing variants, and sharing their best practices.

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“…The 'technological/managerial/engineering route' involves any technology-based interventions and managerial decisions regarding safety that take place at higher levels of the organization. Examples include perfecting radiation safety equipment to reduce radiation doses [4][5][6][7][8][9][10][11] and developing and implementing standard operating procedures to routinely measure (occupational) radiation doses and manage overexposed patients or team members.…”

Section: 1mentioning

confidence: 99%

Team perception of the radiation safety climate in the hybrid angiography suite: A cross-sectional study

Doyen

Vlerick

Soenens

et al. 2020

International Journal of Surgery

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Radiation Dose Reduction During EVAR: Results from a Prospective Multicentre Study (The REVAR Study)

Abstract: With adherence to the ALARA principle and routine application of fusion imaging guidance for EVAR, low radiation exposure compared with the published literature can be achieved in a real world setting.

Cited by 45 publications

References 24 publications

Prostatic artery embolization performed in anteroposterior projections versus steep oblique projections: single centre retrospective comparative analysis

Prostatic artery embolization performed in anteroposterior projections versus steep oblique projections: single centre retrospective comparative analysis

Advanced Image Guidance For Prostatic Artery Embolization – A Multicenter Technical Note

Team perception of the radiation safety climate in the hybrid angiography suite: A cross-sectional study

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