Fluoroscopy Time and Radiation Exposure in TEVAR Versus EVAR: A Systematic Review and Meta-Analysis

Area of Science:

• Medical Imaging
• Interventional Cardiology
• Radiation Oncology

Background:

• Ionizing radiation is a known risk in endovascular surgery.
• Patient radiation exposure varies significantly between different endovascular procedures.

Purpose of the Study:

• To systematically review and meta-analyze patient radiation exposure during endovascular aneurysm repair (EVAR) and thoracic EVAR (TEVAR).
• To compare fluoroscopy time (FT), kerma-area product (KAP), and cumulative air kerma (CAK) between EVAR and TEVAR.

Main Methods:

• A PRISMA-compliant literature search was conducted across major databases (MEDLINE, Scopus, Cochrane Library) from June 2015 to June 2025.
• Seventy-eight studies (73 EVAR, 5 TEVAR) with ≥20 patients were included, reporting FT, KAP, or CAK.
• Random-effects modeling was used for pooled analysis, with risk-of-bias and publication bias assessed.

Main Results:

• TEVAR showed significantly shorter FT (15.25 min) compared to EVAR (28.50 min) (p<0.001).
• No significant differences were found in KAP (151.08 vs. 147.46 Gycm²; p=0.970) or CAK (804.92 vs. 1091.03 mGy; p=0.090).
• High heterogeneity (I²>85%) was observed; only 11.5% of studies reported ALARA compliance, and fusion imaging was used infrequently (9%).

Conclusions:

• Radiation exposure during EVAR and TEVAR is variable, influenced by anatomy, technology, and practice.
• While TEVAR has shorter FT, its KAP values are comparable or higher than EVAR, potentially due to thoracic imaging geometry.
• Limited data for TEVAR restrict definitive comparative conclusions.