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Radiation exposure in endovascular procedures.

Erika R Ketteler1, Kellie R Brown

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Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Radiation Safety

Background:

  • Percutaneous techniques in peripheral vascular disease management position vascular surgeons as supervisors of fluoroscopy and radiation protection.
  • Radiation is an invisible hazard during endovascular interventions, posing challenges for surgeon comprehension and enforcement of safety protocols.

Purpose of the Study:

  • To review general endovascular radiation considerations for common procedures.
  • To highlight factors influencing radiation exposure in endovascular interventions.

Main Methods:

  • Review of general radiation considerations for endovascular aneurysm repair (EVAR) and peripheral interventions.

Main Results:

  • Peripheral atherectomy procedures result in the highest estimated skin doses.
  • Renal interventions, visceral angioplasty/stenting, and embolization procedures also show high peak skin doses.
  • Patients with a high body mass index (BMI) can experience up to three times higher peak skin doses compared to normal BMI patients.

Conclusions:

  • Radiation exposure levels are influenced by endovascular procedure type, patient body habitus, and surgeon safety practices.
  • Radiation exposure risks should be integrated into the informed consent process, similar to other medical procedures.
  • Monitoring radiation exposure is crucial and should parallel the surgeon's monitoring of patient morbidity and mortality.