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Estimation of the Added Cancer Risk Derived From EVAR and CTA Follow-Up.

Bharti Singh1,2, Martin Andersson3,4, Andreas Edsfeldt2,5,6

  • 1Vascular Center Malmö-Lund, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.

Journal of Endovascular Therapy : an Official Journal of the International Society of Endovascular Specialists
|December 23, 2023
PubMed
Summary

The risk of developing cancer after infrarenal Endovascular Aneurysm Repair (EVAR) and CTAs is 1 in 219 patients. Minimizing follow-up CTAs can significantly reduce this radiation-induced cancer risk.

Keywords:
EVARfollow-upmalignancyradiation

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Area of Science:

  • Medical Imaging and Radiation Oncology
  • Vascular Surgery
  • Oncology

Background:

  • Endovascular Aneurysm Repair (EVAR) is a common procedure for infrarenal Abdominal Aortic Aneurysms (AAA).
  • Postoperative surveillance often involves regular Computer Tomography Angiographies (CTAs), leading to cumulative radiation exposure.
  • Assessing the long-term cancer risk associated with EVAR and its follow-up imaging is crucial for patient management.

Purpose of the Study:

  • To evaluate the risk of radiation-induced cancer in patients undergoing infrarenal EVAR.
  • To differentiate the contributions of the EVAR procedure and preoperative/postoperative CTAs to cancer risk.
  • To estimate the Lifetime Attributable Risk (LAR) of cancer for various organs.

Main Methods:

  • Organ-specific absorbed radiation doses were calculated from patient data (95 for CTA, 45 for EVAR).
  • Lifetime Attributable Risk (LAR) cancer predictions were computed for 14 organs.
  • Life expectancy data from a prior EVAR cohort were utilized.

Main Results:

  • The total excess cancer risk was estimated at 0.0046 (1 in 220 patients) over 15 years.
  • The EVAR procedure and preoperative CTAs accounted for 38% of the total excess risk.
  • Eliminating follow-up CTAs would reduce the excess risk to 0.0018 (1 in 560 patients).

Conclusions:

  • Approximately 1 in 219 patients undergoing infrarenal EVAR face a lifetime risk of cancer due to radiation exposure.
  • The majority of this risk stems from annual postoperative CTAs.
  • Reducing the frequency or necessity of follow-up CTAs is recommended to mitigate radiation-induced cancer risk.