Patient radiation exposure during percutaneous endovascular revascularization of the lower extremity

• Published in: Journal of vascular surgery 2013-12, Vol.58 (6), p.1556-1562
• Main Authors: Segal, Einat, MD, Weinberg, Ido, MD, MSc, Leichter, Isaac, PhD, Klimov, Alexander, MD, Giri, Jay, MD, MPH, Bloom, Allan I., MD
• Format: Article
• Language: English
• Subjects: Aged; Female; Femoral Artery - diagnostic imaging; Femoral Artery - surgery; Fluoroscopy - adverse effects; Fluoroscopy - methods; Follow-Up Studies; Humans; Incidence; Intermittent Claudication - diagnostic imaging; Intermittent Claudication - surgery; Intraoperative Period; Israel - epidemiology; Male; Radiation Dosage; Radiation Injuries - epidemiology; Retrospective Studies; Risk Assessment - methods; Risk Factors; Stents; Surgery; Time Factors
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2013.06.016

Background Percutaneous endovascular revascularization is emerging as the first line treatment for peripheral artery disease for both intermittent claudication and chronic critical limb ischemia. Radiation doses for these interventions have not been well documented. Methods A single center retrospective study of therapeutic endovascular lower extremity interventions performed between September 2006 and December 2011 was undertaken. Collected data included patient demographics, procedure indication, procedural access, anatomic location of occlusive disease (pelvis, thigh, below-knee, or multilevel), and radiation exposure parameters including dose area product (DAP) and fluoroscopy time. Results Data was available for 382 procedures performed in 313 patients. Eighteen procedures bilateral procedures were excluded. Access site and complete anatomic data were available for 346 procedures. DAP was significantly higher for procedures performed in the pelvis compared with thigh procedures (179.6 vs 63.2 Gy*cm2 ; P  < .0001) and below-knee procedures (179.6 vs 28.9 Gy*cm2 ; P  < .0001), despite shorter fluoroscopy times (11.8 vs 16.4 minutes; P  < .0001 and 11.1 vs 31.06 minutes; P  < .0001, respectively). Procedure access-site affected radiation dose as well; contralateral up-and-over access resulted in a higher DAP than antegrade access (112.2 vs 42.6 Gy*cm2 ; P  < .0001). In a multivariable analysis, anatomic location of the procedure showed the strongest association with radiation dose ( P  < .0001). Conclusions Percutaneous endovascular revascularization for lower extremity peripheral artery disease involves a substantial radiation dose, comparable, on average, to a computed tomography scan of the abdomen and pelvis. Procedures performed in the pelvis for intermittent claudication involve more radiation than thigh or below-knee procedures for chronic critical limb ischemia. Radiation dose should be considered when planning these procedures.