A procedural step analysis of radiation exposure in fenestrated endovascular aortic repair

Mark Rockley; Petroula Nana; Aya Rebet; Dominique Fabre; Stéphan Haulon

doi:10.1016/j.jvs.2024.02.006

A procedural step analysis of radiation exposure in fenestrated endovascular aortic repair

J Vasc Surg. 2024 Jun;79(6):1306-1314.e2. doi: 10.1016/j.jvs.2024.02.006. Epub 2024 Feb 16.

Authors

Mark Rockley¹, Petroula Nana², Aya Rebet³, Dominique Fabre², Stéphan Haulon⁴

Affiliations

¹ Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris Saclay University, Paris, France; Division of Vascular Surgery, University of Ottawa, Ottawa, Ontario, Canada.
² Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris Saclay University, Paris, France.
³ GE HealthCare, Buc, France.
⁴ Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, Paris Saclay University, Paris, France. Electronic address: haulon@hotmail.com.

PMID: 38368998
DOI: 10.1016/j.jvs.2024.02.006

Abstract

Objective: Radiation exposure during complex endovascular aortic repair may be associated with tangible adverse effects in patients and operators. This study aimed to identify the steps of highest radiation exposure during fenestrated endovascular aortic repair (FEVAR) and to investigate potential intraoperative factors affecting radiation exposure.

Methods: Prospective data of 31 consecutive patients managed exclusively with four-fenestration endografts between March 1, 2020, and July 1, 2022 were retrospectively analyzed. Leveraging the conformity of the applied technique, every FEVAR operation was considered a combination of six overall stages composed of 28 standardized steps. Intraoperative parameters, including air kerma, dose area product, fluoroscopy time, and number of digital subtraction angiographies (DSAs) and average angulations were collected and analyzed for each step.

Results: The mean procedure duration and fluoroscopy time was 140 minutes (standard deviation [SD], 32 minutes), and 40 minutes (SD, 9.1 minutes), respectively. The mean air kerma was 814 mGy (SD, 498 mGy), and the mean dose area product was 66.8 Gy cm² (SD, 33 Gy cm²). The percentage of air kerma of the entire procedure was distributed throughout the following procedure stages: preparation (13.9%), main body (9.6%), target vessel cannulation (27.8%), stent deployment (29.1%), distal aortoiliac grafting (14.3%), and completion (5.3%). DSAs represented 23.0% of the total air kerma. Target vessel cannulation and stent deployment presented the highest mean lateral angulation (67 and 63 degrees, respectively). Using linear regression, each minute of continuous fluoroscopy added 18.9 mGy of air kerma (95% confidence interval, 17.6-20.2 mGy), and each DSA series added 21.1 mGy of air kerma (95% confidence interval, 17.9-24.3 mGy). Body mass index and lateral angulation were significantly associated with increased air kerma (P < .001).

Conclusions: Cannulation of target vessels and bridging stent deployment are the steps requiring the highest radiation exposure during FEVAR cases. Optimized operator protection during these steps is mandatory.

Keywords: Fenestrated aortic repair; Lateral angulation; Radiation exposure; Radiation safety.

MeSH terms

Aged
Aged, 80 and over
Angiography, Digital Subtraction
Aortography
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects
Blood Vessel Prosthesis Implantation* / instrumentation
Endovascular Aneurysm Repair
Endovascular Procedures* / adverse effects
Endovascular Procedures* / instrumentation
Female
Fluoroscopy
Humans
Male
Middle Aged
Occupational Exposure / adverse effects
Occupational Exposure / prevention & control
Operative Time
Radiation Dosage*
Radiation Exposure* / adverse effects
Radiation Exposure* / prevention & control
Radiography, Interventional / adverse effects
Retrospective Studies
Risk Assessment
Risk Factors
Stents
Time Factors
Treatment Outcome