Patient radiation exposure for endovascular deep venous interventions

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Imaging

Background:

• Central venous outflow obstructive diseases, including deep vein thrombosis (DVT) and inferior vena cava (IVC) reconstruction, are increasingly managed with endovascular techniques.
• Assessing cumulative radiation exposure is crucial for patient safety, especially in younger populations who may require repeat procedures.

Purpose of the Study:

• To evaluate the total radiation dose (measured in dose-area product and fluoroscopy time) from preoperative, periprocedural, and follow-up imaging in patients undergoing endovascular deep venous interventions.
• To compare radiation exposure from venous interventions with data from similar arterial procedures.

Main Methods:

• A retrospective review of patients undergoing DVT thrombolysis (upper and lower extremity), iliofemoral venous stenting, and IVC reconstruction between 2012 and 2017.
• Analysis of demographic data, procedural details, and radiation exposure metrics (DAP, FT) from CT scans and interventions.
• Statistical comparison using Mann-Whitney U tests.

Main Results:

• Median cumulative DAP varied by procedure: 9.2 Gycm² for LE DVT thrombolysis, 2.0 Gycm² for UE DVT thrombolysis, 32.4 Gycm² for iliofemoral stenting, and 60.8 Gycm² for IVC reconstruction.
• Median cumulative FT was highest for IVC reconstruction (2846 seconds), followed by LE DVT thrombolysis (981 seconds) and iliofemoral stenting (660 seconds).
• Follow-up procedures contributed additional radiation exposure, with median DAP ranging from 1.9 to 24.3 Gycm².

Conclusions:

• Radiation exposure from endovascular deep venous interventions appears comparable to or less than that of arterial interventions.
• The generally younger age of patients undergoing venous interventions raises concerns about cumulative radiation dose over their lifetime due to potential repeat procedures.