Comparison of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease with Flat-Panel Detectors on Mobile C-arm versus Fixed Systems

Guillou, Marie; Maurel, Blandine; Necib, Hatem; Vent, Pierre-Alexandre; Costargent, Alain; Chaillou, Philippe; Gouëffic, Yann; Kaladji, Adrien

doi:10.1016/j.avsg.2017.08.036

Cited by 14 publications

(5 citation statements)

References 17 publications

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“…Radiation exposure and related parameters in femoropopliteal interventions are significantly influenced by lesion length and complexity, which complicates direct comparisons of this single case to literature examples. Literature that reported on radiation use in femoropopliteal interventions mainly included TASC A or B lesions, which are less complex than the TASC D lesion described in this case, and did not report separate data on complex lesions [ 6 , 7 , 8 , 9 , 10 , 11 ]. Moreover, FORS technology is currently limited to improving endovascular navigation and it would be better to look specifically at the radiation-reducing effect at this stage of the procedure.…”

Section: Discussionmentioning

confidence: 86%

Superficial Femoral Artery Recanalization Using Fiber Optic RealShape Technology

et al. 2022

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Purpose: Report of a successful case of endovascular recanalization of an occluded superficial femoral artery (SFA) using Fiber Optic RealShape (FORS) technology. Case Report: A 79-year-old male was referred for evaluation of multiple ischemic pretibial ulcers of the right lower extremity. Computed tomography–angiography (CTA) imaging confirmed significant stenosis of the right common femoral artery (CFA) and an occlusion of the SFA from its origin to the Hunter’s canal. The patient was treated with a hybrid surgical procedure: an endarterectomy of the CFA and SFA origin was performed combined with an endovascular recanalization of the occluded SFA using FORS technology. During recanalization, the FORS guidewire slowly twisted subintimally around the occluded lumen of the SFA, maintaining the created corkscrew shape after pre-dilation with the percutaneous transluminal angioplasty (PTA) balloon and subsequent stenting. Conclusions: FORS technology can be successfully used during recanalization of an occluded SFA without the use of fluoroscopy. The corkscrew shape formed during recanalization in this case was retained during PTA balloon pre-dilation and stenting; this potentially improves hemodynamics and thereby reduces the risk of in-stent restenosis. However, expanding patient series and longer follow-up data are needed to increase the understanding of the feasibility and effectiveness of using FORS in the treatment of peripheral arterial occlusive disease.

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Section: Discussionmentioning

confidence: 86%

Superficial Femoral Artery Recanalization Using Fiber Optic RealShape Technology

et al. 2022

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“…A different investigation showed that lower-limb revascularization has equivalent technical success using either fixed or mobile modalities. 10 Previous comparisons of TCAR in hybrid ORs or with portable C-arm have not been evaluated, but there are existing studies comparing outcomes of other endovascular interventions in these settings. A single-institution study in 2020 reviewed a series of 77 EVARs, of which 42 were performed with portable C-arm and 35 in a hybrid OR.…”

Section: Discussionmentioning

confidence: 99%

“…A different investigation showed that lower-limb revascularization has equivalent technical success using either fixed or mobile modalities. 10…”

Section: Discussionmentioning

confidence: 99%

Fixed compared to mobile imaging arms for transcarotid artery revascularization

et al. 2022

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Objective Transcarotid artery revascularization (TCAR) is a new surgical option for carotid artery stenosis. While this procedure is optimally performed in hybrid operating rooms (OR), it is currently unclear whether it could be safely performed using portable, C-arm fluoroscopy with equivalent results. The aim of this study is to determine whether there are differences in intraoperative and perioperative outcomes stratified by imaging modality. Methods A retrospective review of all TCAR procedures attempted within our health system was performed, capturing all cases between September 2017 and May 2022. Procedures were divided into 2 cohorts, based on whether they were performed in a hybrid OR or with portable, C-arm in a standard OR. Patient demographics, intraoperative results, and postoperative outcomes were compared using univariate strategies. Results A total of 503 patients were included for review, of which 422 were performed in a hybrid OR (84%) and 81 were performed using a portable C-arm (16%). Intraoperatively, an increased estimated blood loss (47.7 ± 54.7 vs 26.1 ± 26.9 mLs, p < 0.01) and operative time was found in the cases performed in a hybrid OR. However, the fluoroscopy time was lower (4.0 ± 2.6 vs 5.2 ± 5.8 min, p = 0.01) in the setting of advanced intraoperative imaging. Postoperatively, we found no differences with respect to myocardial infarction (0.2% vs. 0%, p > 0.99), stroke (2.4% vs. 2.5%, p = 0.96), or death (0.7% vs. 2.5%, p = 0.15) between groups. Conclusions While there are some intraoperative variabilities between TCAR performed in hybrid versus standard ORs, postoperative outcomes are comparable. Therefore, the lack of a hybrid room should not be a deterrent to the adoption of TCAR.

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“…The aim of this study was to gain a better understanding of the scatter radiation environment in a hybrid OR during spine surgery, and to investigate the difference in the occupational radiation exposure depending on the imaging device used: hCBCT, oCBCT, C-arm. [19][20][21] To assess staff radiation dose, the occupational dose Hp (10) was measured at different positions in the OR, using different imaging protocols and RPS. Previous publications have assessed occupational exposure in vascular interventional surgery, comparing hybrid CBCT systems, and with mobile 2D fluoroscopy C-arm systems.…”

Section: Discussionmentioning

confidence: 99%

Radiation distribution in a hybrid operating room, utilizing different X-ray imaging systems: investigations to minimize occupational exposure

Cewe

Vorbau

Omar

et al. 2021

J NeuroIntervent Surg

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ObjectivesTo reduce occupational radiation exposure in a hybrid operating room (OR) used for three-dimensional (3D) image guided spine procedures. The effects of staff positioning, different X-ray imaging systems, and freestanding radiation protection shields (RPSs) were considered.MethodsAn anthropomorphic phantom was imaged with a robotic ceiling mounted hybrid OR C-arm cone beam CT (hCBCT), a mobile O-arm CBCT (oCBCT), and a mobile two-dimensional C-arm fluoroscopy system. The resulting scatter doses were measured at different positions in the hybrid OR using active personal dosimeters and an ionization chamber. Two types of RPSs were evaluated.ResultsUsing the hCBCT system instead of the oCBCT system reduced the occupational radiation dose on average by 22%. At 200 cm from the phantom, scatter doses from the hCBCT were 27% lower compared with the oCBCT. One rotational acquisition with hCBCT or oCBCT corresponded to 12 or 16 min of fluoroscopy with the C-arm, respectively. The scatter dose decreased by more than 90% behind an RPS. However, the protection was slightly less effective at 60 cm behind the RPS, due to tertiary scatter from the surroundings.ConclusionsFor 3D image guided spine procedures in the hybrid OR, occupational radiation exposure is lowered by using hCBCT rather than oCBCT. Radiation exposure can also be decreased by optimal staff positioning in the OR, considering distance to the source and positioning relative to the walls, ceiling, and RPS. In this setting and workflow, staff can use RPSs instead of heavy aprons during intraoperative CBCT imaging, to achieve effective whole body dose reduction with improved comfort.

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Comparison of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease with Flat-Panel Detectors on Mobile C-arm versus Fixed Systems

Cited by 14 publications

References 17 publications

Superficial Femoral Artery Recanalization Using Fiber Optic RealShape Technology

Superficial Femoral Artery Recanalization Using Fiber Optic RealShape Technology

Fixed compared to mobile imaging arms for transcarotid artery revascularization

Radiation distribution in a hybrid operating room, utilizing different X-ray imaging systems: investigations to minimize occupational exposure

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