Stefan Stanev1, Desislava Kostova-Lefterova2,3,4, Svetla Dineva2,4,5. 1. St. George University Hospital, Plovdiv, Bulgaria. 2. National Cardiology Hospital, Sofia, Bulgaria. 3. Medical University - Pleven, Pleven, Bulgaria. 4. Aleksandrovska University Hospital, Sofia, Bulgaria. 5. Medical University - Sofia, Sofia, Bulgaria.
Abstract
OBJECTIVES: Constantly increasing number of procedures performed - endovascular or hybrid in patients with aortoiliac occlusive disease during the last decades finds its explanation in the lower morbidity and mortality rates, compared to bypass surgery. The purpose of the current survey was to estimate patients' radiation exposure in aortoiliac segment after endovascular or hybrid revascularization and to study the main factors which have direct contribution. METHODS: A retrospective study of 285 procedures conducted with the help of a mobile C-arm system in 223 patients was performed. Procedures were grouped according to criteria such as: type of intervention, vascular access, level of complexity and operating team. Different analyses were performed within the groups and dose values. RESULTS: The median values of kerma-air product (KAP), the number of series and the peak skin dose (PSD) significantly increase with the increasing number of vascular accesses: for one access (16.68 Gy.cm2, 6 and 336 mGy), for two (56.93 Gy.cm2, 11 and 545 mGy), and for three (102.28 Gy.cm2, 15 and 781 mGy). Significant dependence was observed in the case of single access site between the type of access and the dose values: hybrid and retrograde common femoral artery/superficial femoral artery (CFA/SFA) endovascular accesses, 10.06 Gy.cm2/301 mGy and 13.23 Gy.cm2/318 mGy respectively, in contrast with the contralateral CFA and left brachial access, 33 Gy.cm2/421 mGy and 38.33 Gy.cm2/448 mGy respectively. CONCLUSION: The results demonstrate that the most important factors increasing the dose values are number and type of vascular accesses, followed by the combination and number of implanted stents with the complexity of the procedure. The PSD values for a single procedure were between 2 and 12 times lower than those IAEA proposed as trigger levels for radiation-induced erythema. This study shows that trigger levels were not reached even for patients with repeated procedures in the same segment in 1-year period. ADVANCES IN KNOWLEDGE: The study gives important understanding and clarity on the growing awareness for dose-modifying factors during endovascular and hybrid revascularization of aortoiliac segment.
OBJECTIVES: Constantly increasing number of procedures performed - endovascular or hybrid in patients with aortoiliac occlusive disease during the last decades finds its explanation in the lower morbidity and mortality rates, compared to bypass surgery. The purpose of the current survey was to estimate patients' radiation exposure in aortoiliac segment after endovascular or hybrid revascularization and to study the main factors which have direct contribution. METHODS: A retrospective study of 285 procedures conducted with the help of a mobile C-arm system in 223 patients was performed. Procedures were grouped according to criteria such as: type of intervention, vascular access, level of complexity and operating team. Different analyses were performed within the groups and dose values. RESULTS: The median values of kerma-air product (KAP), the number of series and the peak skin dose (PSD) significantly increase with the increasing number of vascular accesses: for one access (16.68 Gy.cm2, 6 and 336 mGy), for two (56.93 Gy.cm2, 11 and 545 mGy), and for three (102.28 Gy.cm2, 15 and 781 mGy). Significant dependence was observed in the case of single access site between the type of access and the dose values: hybrid and retrograde common femoral artery/superficial femoral artery (CFA/SFA) endovascular accesses, 10.06 Gy.cm2/301 mGy and 13.23 Gy.cm2/318 mGy respectively, in contrast with the contralateral CFA and left brachial access, 33 Gy.cm2/421 mGy and 38.33 Gy.cm2/448 mGy respectively. CONCLUSION: The results demonstrate that the most important factors increasing the dose values are number and type of vascular accesses, followed by the combination and number of implanted stents with the complexity of the procedure. The PSD values for a single procedure were between 2 and 12 times lower than those IAEA proposed as trigger levels for radiation-induced erythema. This study shows that trigger levels were not reached even for patients with repeated procedures in the same segment in 1-year period. ADVANCES IN KNOWLEDGE: The study gives important understanding and clarity on the growing awareness for dose-modifying factors during endovascular and hybrid revascularization of aortoiliac segment.
Authors: Michele Piazza; Joseph J Ricotta; Thomas C Bower; Manju Kalra; Audra A Duncan; Stephen Cha; Peter Gloviczki Journal: J Vasc Surg Date: 2011-04-30 Impact factor: 4.268
Authors: Augusto Gallino; Victor Aboyans; Curt Diehm; Francesco Cosentino; Hans Stricker; Erling Falk; Olaf Schouten; John Lekakis; Beatrice Amann-Vesti; Francesco Siclari; Pavel Poredos; Salvatore Novo; Marianne Brodmann; Karl-Ludwig Schulte; Charalambos Vlachopoulos; Raffaele De Caterina; Peter Libby; Iris Baumgartner Journal: Eur Heart J Date: 2014-03-03 Impact factor: 29.983
Authors: Luuk Smeets; Gerrit-Jan de Borst; Jean-Paul de Vries; Jos C van den Berg; Gwan H Ho; Frans L Moll Journal: J Vasc Surg Date: 2003-12 Impact factor: 4.268