"Hands Off": Best Practice Radiation Safety is Rarely Achieved in Microcatheter Angiography

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Radiation Safety

Background:

• Microcatheter angiography (MA) is used to assess iliofemoral access suitability and detect complications in endovascular procedures.
• Operator hands are particularly vulnerable to radiation exposure during MA.
• Current practices may not adhere to optimal radiation safety standards in MA.

Purpose of the Study:

• To evaluate the prevalence and radiation safety practices of MA in elective percutaneous endovascular aneurysm repair (pEVAR).
• To determine the rate of direct operator radiation exposure during MA.
• To assess the utility of MA in detecting access-related complications.

Main Methods:

• Retrospective review of 144 patients undergoing elective pEVAR from 2020-2023.
• Analysis of operative reports and digital subtraction angiography (DSA) to identify pre- and post-large bore MA.
• Primary endpoint: rate of direct operator exposure; Secondary endpoints: access complications and radiation dose area product (DAP).

Main Results:

• A total of 410 MA procedures were performed across 282 access sites.
• Direct operator exposure occurred in 56% of MA procedures, with individual rates ranging from 51-71%.
• Access-related complications were low (6.9%), with MA detecting only four.

Conclusions:

• MA is routinely used in elective pEVAR, but radiation safety best practices are infrequently achieved.
• The rate of direct operator exposure during MA is high.
• Selective use of MA and development of best practice guidelines are recommended due to high operator exposure and low complication detection rates.