Deterministic effects after fenestrated endovascular aortic aneurysm repair

Area of Science:

• Medical Imaging and Radiation Oncology
• Vascular Surgery
• Patient Safety and Radiation Protection

Background:

• Fenestrated endovascular aortic aneurysm repair (FEVAR) involves high radiation doses, posing a risk for deterministic skin injuries.
• Previous retrospective studies showed no skin injuries despite high peak skin doses (PSDs).
• This study aimed to investigate potential under-reporting of skin injuries in FEVAR procedures.

Purpose of the Study:

• To examine deterministic radiation effects on the skin in FEVAR patients.
• To implement procedural changes to enhance the detection of skin injuries.
• To evaluate the relationship between radiation dose and skin injury incidence.

Main Methods:

• Included FEVAR patients with radiation dose ≥ 5 Gy reference air kerma (RAK).
• Patients underwent daily skin examinations until discharge and follow-ups at 2, 4 weeks, and 3, 6 months.
• Peak skin dose (PSD) distributions were calculated and validated; cumulative doses were considered for patients with multiple procedures.

Main Results:

• 21 FEVAR patients met the inclusion criteria with an average RAK of 7.6 Gy and mean PSD of 4.8 Gy.
• Fifty-two percent of patients had multiple procedures, with a mean RAK of 10.0 Gy and mean PSD of 6.6 Gy.
• No radiation-induced skin injuries (erythema, epilation, necrosis) were observed, despite high radiation doses and cumulative exposure.

Conclusions:

• Deterministic skin injuries appear uncommon after FEVAR, even with substantial radiation exposure.
• Comprehensive postoperative skin examinations and patient questioning did not reveal any radiation-induced injuries.
• Radiation-induced skin injuries are likely multifactorial, with factors beyond just radiation dose influencing their occurrence.