Operator-controlled Imaging Significantly Reduces Radiation Exposure during EVAR.

St George's Vascular Institute, 4th Floor, St James Wing, St George's Healthcare NHS Trust, Blackshaw Road, London SW17 0QT, UK. Electronic address: .
European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery (Impact Factor: 2.92). 08/2012; 44(4):395-8. DOI: 10.1016/j.ejvs.2012.08.001
Source: PubMed

ABSTRACT Adoption of endovascular aneurysm repair (EVAR) has led to significant reductions in the short-term morbidity and mortality associated with abdominal aortic aneurysm (AAA) repair. However, EVAR may expose both patient and interventionalist to potentially harmful levels of radiation, particularly as more complex procedures are undertaken. The aim of this study was to assess whether changing from radiographer-controlled imaging to a system of operator-controlled imaging (OCI) would influence radiation exposure, screening time or contrast dose during EVAR.
Retrospective analysis identified patients that had undergone elective EVAR for infra-renal AAA before or after the change to operator-controlled imaging. Data were collected for radiation dose (measured as dose area product; DAP), screening time, total delivered contrast volume and operative duration. Data were also collected for maximum aneurysm diameter, patient age, gender and body mass index.
122 patients underwent EVAR for infra-renal AAA at a single centre between January 2011 and December 2011. 57 of these were prior to installation of OCI and 65 after installation. Median DAP was significantly lower after installation of OCI (4.9 mGy m(2); range 1.25-13.3) than it had been before installation (6.9 mGy m(2); range 1.91-95.0) (p = 0.005). Median screening times before and after installation of OCI were 20.0 min and 16.2 min respectively (p = 0.027) and median contrast volumes before and after the change to OCI were 100 ml and 90 ml respectively (p = 0.21).
Introduction of operator-controlled imaging can significantly reduce radiation exposure during EVAR, with particular reduction in the number of 'higher-dose' cases.

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    ABSTRACT: Access to a hybrid endovascular suite is touted as a necessity for advanced endovascular aneurysm repair (EVAR) to improve imaging accuracy and safety. Yet there remain little data documenting this intuitive advantage of a hybrid setup versus a traditional operating room (OR) utilizing a portable fluoroscopic unit (C-arm) for imaging. We hypothesized that standard elective EVAR performed in a hybrid suite would improve procedural efficiency and accuracy, as well minimize patient exposure to both contrast and radiation. We retrospectively reviewed a single attending surgeon's EVAR practice, which encompassed the transition to a hybrid endovascular suite (opened July 2010). Only consecutive abdominal aneurysms were included in the analysis to attempt to create a homogenous cohort. All emergent, aorto-uni-iliac (AUI), snorkel, fenestrated, or hybrid procedures were excluded. Standard variables evaluated and compared between the two study subgroups included fluoroscopy time, operative time, contrast use, stent-graft component utilization, complication rates, and short-term endoleaks. From January 2008 to August 2012, we performed 213 EVAR procedures for abdominal aortic aneurysms. After excluding emergent, AUI, snorkel, or hybrid procedures, we analyzed 109 routine EVARs. Fifty-eight consecutive cases were done in the OR with a C-arm until July 2010, and the last 51 cases were done in the hybrid room. Both groups were well matched in terms of demographics, aneurysm morphology, and procedural characteristics. No difference was found in terms of complication rates or operative mortality, although there was a trend towards decreased fluoroscopy time, type I/III endoleaks, and a number of additional endograft components utilized. Compared with patients repaired in the OR/C-arm, EVAR done in the hybrid room resulted in less total OR time and contrast usage (p < .05). Routine EVAR performed in a hybrid fixed-imaging suite affords greater efficiency and less harmful exposure of contrast and possible radiation to the patient. Accurate imaging quality and deployment is associated with less need for additional endograft components, which should lead to improved cost efficiency. Confirmation of these findings might be necessary in a randomized control trial to fully justify the capital expenditure necessary for hybrid endovascular suites.
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