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

Ionizing radiation exposure is inherent to endovascular surgery and is associated with adverse health effects. This systematic review and meta-analysis compared patient radiation exposure during endovascular aneurysm repair (EVAR) and thoracic endovascular aneurysm repair (TEVAR), focusing on fluoroscopy time (FT), kerma-area product (KAP), and cumulative air kerma (CAK).

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant search of MEDLINE, Scopus, and the Cochrane Library (June 2015-June 2025) identified English-language studies with ≥20 patients reporting FT, KAP, or CAK during elective EVAR or TEVAR. Pooled means with 95% confidence intervals were calculated using random-effects modeling. Risk of bias was assessed with ROBINS-I version 2 and publication bias with Egger's test and funnel plots.

Seventy-eight studies (73 EVAR and 5 TEVAR) met inclusion criteria. TEVAR demonstrated significantly shorter FT than EVAR (15.25 vs. 28.50 min; P < 0.001). No significant differences were observed in KAP (151.08 vs. 147.46 Gycm²; P = 0.970) or CAK (804.92 vs. 1,091.03 mGy; P = 0.090). Heterogeneity was high across all outcomes (I² > 85%). Only 11.5% of studies reported explicit as low as reasonably achievable compliance, and fusion imaging was used in 9%, more frequently in TEVAR. Publication bias was evident for all radiation metrics.

Radiation exposure during EVAR and TEVAR varies substantially, reflecting anatomical complexity, imaging technology, and procedural practice. TEVAR required shorter FT but produced similar or higher KAP values, likely related to thoracic imaging geometry. Limited TEVAR data restrict the strength of comparative conclusions.