Patients' radiation doses during percutaneous endovascular procedures in arteries of the lower limbs

Percutaneous endovascular revascularisation interventions are increasingly used in treatment of lower extremity artery disease and may expose patients to substantial radiation.

Dose-area product (DAP) was retrospectively analysed in 1063 consecutive interventions performed in adult patients with lower extremity artery disease in a single tertiary medical centre. Differences between procedure types, stratified according to anatomical region and arterial lesion complexity were evaluated.

Median DAP for diagnostic interventions was 35.6 (15.0-52.4) Gy cm² in aorto-below-knee arteriography and 3.2 (2.0-4.5) Gy cm² in ipsilateral femoral arteriography (p < 0.001). For angioplasty without stenting, median DAP was 53.4 (28.6-87.4) Gy cm² for pelvic interventions vs. 5.9 (4.3-8.6) Gy cm² for antegrade ipsilateral femoropopliteal interventions (p < 0.001). For stenting, median DAP was 54.9 (32.5-91.2) Gy cm² for pelvic interventions vs. 8.3 (6.0-12.3) Gy cm² for antegrade ipsilateral femoropopliteal interventions (p < 0.001). Inside the same anatomical region, diagnostic interventions were associated with significantly lower DAP than therapeutic interventions. Stenting vs no stenting increased DAP values only in antegrade ipsilateral femoropopliteal interventions (8.3 (6.0-12.3) vs 5.9 (4.3-8.6) Gy cm² (p < 0.001). Arterial lesion complexity affected DAP values only in antegrade ipsilateral femoropopliteal therapeutic interventions.

The most important factor influencing patients' radiation doses was the anatomical region. Pelvic interventions were associated with 6-11-times higher DAP values than femoropopliteal interventions with antegrade ipsilateral approach. Stenting and complexity of lesions increased DAP only in antegrade ipsilateral femoropopliteal interventions.