The impact of radiation dose exposure during endovascular aneurysm repair on patient safety

Abstract

EVAR and the follow-up investigations involve substantial amounts of radiation, with well-recognized carcinogenic risks. Because patient safety is paramount, radiation exposure should be minimized. This may be possible by standardizing radiation exposure throughout the United Kingdom by implementing national guidelines and considering other imaging modalities for follow-up.

Management of peripheral arterial disease: Role of computed tomography angiography and magnetic resonance angiography

“…Usually, a CTA is performed three month after EVAR and every year thereafter if no endoleak is detected. This surveillance increases the cost and exposes the patient to the hazard of ionizing radiation and iodine contrast nephrotoxicity [85,86]. To minimize contrast injection, only one acquisition during the arterial phase is recommended [87].…”

Radiation exposure in endovascular repair of abdominal and thoracic aortic aneurysms

“…Deterministic effects of ionizing radiation are dose-dependent and usually occur only beyond a threshold of 2 Gy. 1,8,31 Once the 2-Gy threshold has been reached, early transient erythema of the skin may be noted in as soon as 24 to 48 hours. 32 Other deterministic effects include epilation, desquamation, and skin necrosis; those usually do not manifest until later.…”

“…While during EVAR the patient is exposed to significant quantities of radiation, the preoperative and postoperative surveillance imaging represents the largest percentage of radiation exposure in these patients. 1,8,22,23,26 According to Zoli et al, follow-up CT imaging represented 87% of the total radiation exposure after 1 year, 92% at 5 years, and 96% in a lifetime. 1 This study concluded that a 2-year radiation exposure greater than 100 mSv with a life expectancy greater than 15 years led to a lifetime risk increase in radiation-induced leukemia and solid tumor malignancy of greater than 2.7%.…”

“…Patients that are candidates for an additional operation are exposed to even higher amounts of radiation. In a study from Jones, 8 22 of 320 patients undergoing elective EVAR and 4 of 64 undergoing emergent EVAR required an additional procedure, which added 31.8 6 29.7 Gycm 2 and 49.9 6 44.0 Gycm 2 of radiation, respectively, to the patient.…”

“…1 Virtually all patients undergoing EVAR have a preoperative computed tomography (CT) scan, intraoperative fluoroscopic imaging, and lifelong surveillance imaging. 1,[8][9][10] Variation in technique, screening, operator's experience, and surveillance protocol, along with the equipment used for patients undergoing EVAR, may affect the dose of radiation exposure to the patient and staff involved. The goal of this study was to review the current understanding of radiation exposure during EVAR and the most commonly used techniques to reduce the burden of radiation on all of those involved.…”