Radiation exposure in endovascular procedures

The introduction of percutaneous techniques to treat patients with peripheral vascular disease has placed the vascular surgeon in the unique role as the fluoroscopy supervisor overseeing the radiation protection for patient, self, staff, and trainee. Since radiation is an invisible threat in endovascular interventions, attention to protection may be challenging for the surgeon to understand and enforce.

General endovascular radiation considerations for endovascular aneurysm repair (EVAR) and peripheral interventions are reviewed.

Peripheral atherectomy has the highest estimated skin doses of all endovascular procedures. Renal interventions, visceral balloon angioplasty and stenting, and embolization procedures are some of the procedures that have the highest peak skin doses. Patients with high body mass index (BMI) have been found to have up to three times higher peak skin doses than patients with normal BMI.

The degree of radiation exposure is dependent on the type of endovascular procedure, the patient's body habitus, and also the safety habits of the surgeon. Radiation exposure needs addressed in an informed consent process as is required for other procedures. Radiation exposure risks also need monitoring just as a surgeon monitors individual morbidity and mortality.