Review of the Use of Ionizing Radiation in Endovascular Aneurysm Repair

Background Endovascular aneurysm repair (EVAR) is becoming the mainstay treatment of abdominal aortic aneurisms (AAA). The postoperative follow-up regime includes a lifelong series of CT angiograms (CTAs) at different intervals in addition to EVAR, which will confer significant cumulative radiation exposure over time. Purpose To examine the impact of age and follow-up regime over time on cumulative radiation exposure and attributable cancer risk after EVAR. Material and Methods We calculated a mean effective dose (ED) for the EVAR procedure, CTA, and plain abdominal X-rays (PAX). Cumulative ED was calculated for standard, complex, and simplified surveillance over 5, 10, and 15 years for different age groups. Results For EVAR, the mean ED was 34 mSv (range, 12-75 mSv) per procedure. For PAX, the ED was 1.1 mSv (range, 0.3-4.4 mSv), and for CTA it was 8.0 mSv (range, 2-20 mSv). For a 55-year-old man, an attributable cancer risk (ACR) in standard surveillance at 5 and 15 years of follow-up was 0.35% and 0.65%, respectively. The corresponding values were 0.22% and 0.37% for a 75-year-old man. When using a simplified follow-up, the ACRs for a 55-year-old at 5 and 15 years were 0.30% and 0.37%, respectively. These values were 0.18% and 0.21% for a 75-year-old man. A complex follow-up with half-yearly CTA over similar age and time span doubled the ACR. Conclusion Treating younger patients with EVAR poses a low ACR of 0.65% (15-year standard surveillance) compared to a lifetime cancer risk of 44%. A simplified surveillance should be used if treating younger patients, which will halve the ACR over 15 years.

show abstract

“…3). Dindyal et al concluded that more research is needed to fully understand the effects of radiation exposure during and after EVAR (29).…”

Section: Discussionmentioning

confidence: 99%

Radiation exposure in patients treated with endovascular aneurysm repair: what is the risk of cancer, and can we justify treating younger patients?

et al. 2016

View full text Add to dashboard Cite

show abstract

“…However, there has been an associated cost, including substantial risk of ionizing radiation exposure [86]. Some of the pioneers of endovascular therapy have succumbed to the deleterious consequence of ionizing radiation [87]. Radiation safety practices have made tremendous advances since the discovery of Roentgen's X-rays over 120 years ago.…”

Section: Radiation Exposure As Low As Reasonably Achievable (Alara)mentioning

confidence: 99%

Fundamentals of Medical Radiation Safety: Focus on Reducing Short-Term and Long-Term Harmful Exposures

Alers¹,

Salen²,

Yellapu³

et al. 2019

Vignettes in Patient Safety - Volume 4 [Working Title]

View full text Add to dashboard Cite

This chapter provides an overview of key topics in the area of radiation safety. Three clinical vignettes will serve to frame the review of the literature around both diagnostic radiation exposure and the risk of radioisotope contamination. Advancement in medical technology is rarely innocuous, and the use of radiation as both means to diagnose and treat certain conditions is not an exception. It is very important for clinicians to review the basics of harmful medical radiation exposure since, although seldom encountered, treatment, and outcomes are time sensitive. The advent of newer technology and the widespread availability of equipment will only serve to increase the prevalence of potentially harmful medical radiation exposure. Moreover, this chapter aims to explore current multidisciplinary endeavors to provide safe and efficient use of radiation in medicine. Solely relying on the medical profession for development of safeguards against harmful medical radiation exposure would be an impossible task. This is why it is crucial for professionals such as health physicists, radiation safety enforcement officers, and policy-makers at the state, national, and international level to establish consensus guidelines aimed toward safe, reliable utilization of radiation in medicine. Part of this interdisciplinary approach needs to focus on accurate education of patients. A thorough assessment of acute radiation syndrome, including diagnosis, treatment, and prognostic indicators is also part of this chapter. Furthermore, principles of screening for, and protection from, radiation contamination are outlined. Finally, areas for further research are identified throughout the chapter. The discussion takes into account both US-based and International research and practice guidelines.

show abstract

Third- versus Second-Generation Stent Graft for Endovascular Aneurysm Repair: A Device-Specific Analysis

Bergonti

Teruzzi

Santagostino

et al. 2017

Annals of Vascular Surgery

View full text Add to dashboard Cite

Review of the Use of Ionizing Radiation in Endovascular Aneurysm Repair

Cited by 8 publications

References 72 publications

Radiation exposure in patients treated with endovascular aneurysm repair: what is the risk of cancer, and can we justify treating younger patients?

Radiation exposure in patients treated with endovascular aneurysm repair: what is the risk of cancer, and can we justify treating younger patients?

Fundamentals of Medical Radiation Safety: Focus on Reducing Short-Term and Long-Term Harmful Exposures

Third- versus Second-Generation Stent Graft for Endovascular Aneurysm Repair: A Device-Specific Analysis

Contact Info

Product

Resources

About