Patients’ radiation doses during percutaneous endovascular procedures in arteries of the lower limbs

Abstract

Abstract. Background: Percutaneous endovascular revascularisation interventions are increasingly used in treatment of lower extremity artery disease and may expose patients to substantial radiation. Patients and methods: Dose-area product (DAP) was retrospectively analysed in 1063 consecutive interventions performed in adult patients with lower extremity artery disease in a single tertiary medical centre. Differences between procedure types, stratified according to anatomical region and arterial lesion complexity were evaluated. Results: Median DAP for diagnostic interventions was 35.6 (15.0–52.4) Gy cm2 in aorto-below-knee arteriography and 3.2 (2.0–4.5) Gy cm2 in ipsilateral femoral arteriography (p < 0.001). For angioplasty without stenting, median DAP was 53.4 (28.6–87.4) Gy cm2 for pelvic interventions vs. 5.9 (4.3–8.6) Gy cm2 for antegrade ipsilateral femoropopliteal interventions (p < 0.001). For stenting, median DAP was 54.9 (32.5–91.2) Gy cm2 for pelvic interventions vs. 8.3 (6.0–12.3) Gy cm2 for antegrade ipsilateral femoropopliteal interventions (p < 0.001). Inside the same anatomical region, diagnostic interventions were associated with significantly lower DAP than therapeutic interventions. Stenting vs no stenting increased DAP values only in antegrade ipsilateral femoropopliteal interventions (8.3 (6.0–12.3) vs 5.9 (4.3–8.6) Gy cm2 (p < 0.001). Arterial lesion complexity affected DAP values only in antegrade ipsilateral femoropopliteal therapeutic interventions. Conclusions: The most important factor influencing patients’ radiation doses was the anatomical region. Pelvic interventions were associated with 6–11-times higher DAP values than femoropopliteal interventions with antegrade ipsilateral approach. Stenting and complexity of lesions increased DAP only in antegrade ipsilateral femoropopliteal interventions.

Superficial Femoral Artery Recanalization Using Fiber Optic RealShape Technology

“…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.…”

Distal embolization during percutaneous revascularization of the lower extremity arteries

“…Lesions of proximal part of the femoral artery were treated with contralateral approach. Our intervention protocol is thoroughly described elsewhere [8].…”