Radiation exposure in endovascular repair of abdominal and thoracic aortic aneurysms

Monastiriotis, Spyridon; Comito, Matthew; Labropoulos, Nicos

doi:10.1016/j.jvs.2015.05.033

Cited by 50 publications

(33 citation statements)

References 52 publications

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“…For context, the overall frequency of CSF drainage in the Valiant Evo trial is lower than other stent trials, which ranged from 25.6% to 36.4%. 12,34 The median radiation exposure was higher in the U.S. compared with OUS cases, but whether this finding was due to differences in types of adjunctive procedures or the use of different imaging modalities and strategies 38 is beyond the scope of these trials. The radiation exposure of the Valiant Evo patients as a whole is similar to the 0.8 Gy levels reported by Howells et al 39 and in other TEVAR experiences.…”

Section: Discussionmentioning

confidence: 99%

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Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

Azizzadeh

Desai

Arko

et al. 2019

Journal of Vascular Surgery

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Objective: The Valiant Navion stent graft system (Medtronic, Santa Rosa, Calif) is a new iteration of a thoracic endograft for the treatment of descending thoracic aortic aneurysms. Herein, the 30-day primary safety and efficacy outcomes and secondary end points are presented. Methods:The Valiant EVO global clinical trial is a prospective, nonrandomized, single-arm trial. Patient enrollment occurred from April 2016 to October 2017. The primary end point was defined as access and/or deployment failure and/or a major device effect (MDE), including device-related secondary procedures, device-related mortality, conversion to open surgery, or thoracic aortic aneurysm rupture within 30 days of the index procedure. Other measures of stent graft performance including procedural data, rates of secondary procedures, and frequency of endoleaks are also reported.Results: Of the 87 consecutive patients undergoing thoracic endovascular aneurysm repair who were enrolled, 33 (37.9%) were female with 61 (70.9%) presenting with severe access artery tortuosity and 66 (85.7%) with high thoracic aortic tortuosity per core laboratory evaluation. The mean procedure duration was 88.7 6 53.4 minutes and geographical differences existed such as percutaneous access (37/52 [71.2%]) in the United States and surgical cut down in the outside of the U.S. sites (28/35 [80.0%]). There were no access or deployment failures and only 2.3% of the patients (2/87; P < .0001; performance goal of 16%) experienced a MDE within 30 days of the index procedure. Two secondary procedures (n ¼ 1 retrograde type A dissection; n ¼ 1 aortic arch rupture) were required, and in the first 30 days, two patients died leading to a freedom from all-cause mortality of 97.7%. Endoleaks at 1 month were reported in 2.5% of patients (n ¼ 1 type Ia; n ¼ 1 type II).Conclusions: Access/deployment failures, MDEs, and endoleaks were rare in the first 30 days of the Valiant Evo clinical trial. The Valiant Navion thoracic stent graft system has shown encouraging 30-day results in this challenging cohort and trial patients will continue to be followed through 5 years. (J Vasc Surg 2019;70:1399-408.)

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Section: Discussionmentioning

confidence: 99%

“…The radiation exposure of the Valiant Evo patients as a whole is similar to the 0.8 Gy levels reported by Howells et al 39 and in other TEVAR experiences. 38 Further investigations into the regional differences is warranted to assess if certain management strategies may lead to better patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

Azizzadeh

Desai

Arko

et al. 2019

Journal of Vascular Surgery

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“…The incidence of acute kidney injury following standard EVAR has been reported in up to 18.8% of patients and therefore represents a common problem [3]. Radiation exposure on the other hand may put patients and interventionalists at risk [4,5]. Acute radiation-induced DNA damage has been confirmed in operators performing EVAR cases [6].…”

Section: Introductionmentioning

confidence: 99%

Fusion Imaging Significantly Reduces Contrast and Radiation Exposure During Standard EVAR

Barkhausen¹,

Wiedner²,

Stahlberg³

et al. 2019

RDI

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Background: Standard endovascular aortic repair (EVAR) is frequently performed with few data regarding utilization of 2D-3D fusion imaging (FI). Purpose: To evaluate a) feasibility and safety of 2D-3D FI to guide limb deployment during EVAR and b) efficacy of this technique compared to standard use of digital subtraction angiography (DSA) for guidance. Materials and Methods: Iliac limb deployment by guidance of 2D-3D FI (FUSION group, n=22 limbs) during EVAR was compared to (STANDARD group, n=23 limbs). Retrospectively, we analyzed feasibility (success-rate) and safety (patency of hypogastric artery; type Ib/III endoleak) of FI for limb deployment (FUSION group). Total contrast (ml) and median dose area product (mGy*cm2) per group to visualize the iliac bifurcation were compared. Results: In the FUSION group, limb deployment was performed in 19/22 limbs (86.4%) and all hypogastric arteries were patent at the end of the procedure. Median volumes of contrast per bifurcation were 13.0 ml (RANGE 13–13ml) in the STANDARD and 2.2ml (RANGE 0–13ml) in the FUSION group (p=0.002); median dose area products per bifurcation were 11951mGy*cm2 and 2593.1mGy*cm2 (p=0.001), respectively. Conclusion: Fusion imaging for guidance of limb deployment during standard EVAR is safe and feasible in the majority of procedures and can significantly reduce contrast volume and radiation exposure even if compared with optimal preparation by predicting optimal C-arm positions. Therefore, FI should be used whenever possible

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“…4 Moreover, clinical studies usually present only the cumulative radiation dose per intervention. 5 Although these cumulative dose outcomes are interesting for comparing the mean doses between interventions or treatments or calculating the overall patient risk, they do not correct for the C-arm or patient characteristics. A gap in current research exists describing which factors are the strongest predictors in determining the actual DRs in authentic clinical settings.…”

Section: Introductionmentioning

confidence: 99%

Radiation Awareness for Endovascular Abdominal Aortic Aneurysm Repair in the Hybrid Operating Room. An Instant Patient Risk Chart for Daily Practice

et al. 2017

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Purpose: To determine which patient and C-arm characteristics are the strongest predictors of intraoperative patient radiation dose rates (DRs) during endovascular aneurysm repair (EVAR) procedures and create a patient risk chart. Methods: A retrospective analysis was performed of 74 EVAR procedures, including 16,889 X-ray runs using fixed C-arm imaging equipment. Four multivariate log-linear mixed models (with patient as a random effect) were constructed. Mean air kerma DR (DRAK, mGy/s) and the mean dose area product DR (DRDAP, mGycm2/s) were the outcome variables utilized for fluoroscopy as differentiated from digital subtraction angiography (DSA). These models were used to predict the maximum radiation duration allowed before a 2-Gy skin threshold (for DRAK) or a 500-Gycm2 threshold (for DRDAP) was reached. Results: The strongest predictor of DRAK and DRDAP for fluoroscopy imaging was the radiation protocol, with an increase of 200% when changing from “low” to “medium” and 410% from “low” to “normal.” The strongest predictors of DRAK and DRDAP for DSA were C-arm angulation, with an increase of 47% per 30° of angulation, and body mass index (BMI), with an increase of 58% for every 5-point increase in BMI. Based on these models, a patient with a BMI of 30 kg/m2, combined with 45° of rotation and a field size of 800 cm2 in the medium fluoroscopy protocol has a predicted DRAK of 0.39 mGy/s (or 85.5 minutes until the 2-Gy skin threshold is reached). While using comparable settings but switching the acquisition to a DSA with a “2 frames per second” protocol, the predicted DRAK will be 6.6 mGy/s (or 5.0 minutes until the 2-Gy threshold is reached). Conclusion: X-ray radiation DRs are constantly fluctuating during and between patients based on BMI, the protocols, C-arm position, and the image acquisitions that are used. An instant patient risk chart visualizes these radiation dose fluctuations and provides an overview of the expected duration of X-ray radiation, which can be used to predict when follow-up dose thresholds are reached during abdominal endovascular procedures.

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Radiation exposure in endovascular repair of abdominal and thoracic aortic aneurysms

Cited by 50 publications

References 52 publications

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial

Fusion Imaging Significantly Reduces Contrast and Radiation Exposure During Standard EVAR

Radiation Awareness for Endovascular Abdominal Aortic Aneurysm Repair in the Hybrid Operating Room. An Instant Patient Risk Chart for Daily Practice

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