Thakor Avnesh S, Winterbottom Andrew, Mercuri Mathew, Cousins Claire, Gaunt Michael E
Insights Imaging. 2011 Dec;2(6):699-704. doi: 10.1007/s13244-011-0120-5. Epub 2011 Jul 31.
With increasing experience, endovascular aortic aneurysm repair (EVAR) has been extended to patients with less suitable aorto-iliac anatomy in an attempt to reduce peri-operative mortality. However, more complex EVAR procedures may take longer and can result in higher rates of complications, additional interventional procedures and more frequent radiological imaging, which may offset some of the benefit. This study determined the radiation burden for standard EVAR, as determined by the EVAR-1 trial criteria, and more complex EVAR. METHODS: A total of 123 elective patients aged >60, with aneurysms >5.5 cm who received a bifurcated stent-graft were allocated into a group based on whether or not they fulfilled strict EVAR-1 trial criteria. The mean radiation dose was calculated for each group, together with the additional radiation burden from routine pre- and post-EVAR CT examinations and pre-EVAR iliac artery embolisation. RESULTS: Patients not meeting the EVAR-1 trial criteria had significantly longer fluoroscopic screening times and higher radiation doses. The radiation burden in all patients was higher following exposure from routine CT examinations and following pre-EVAR iliac artery embolisation. CONCLUSION: Whilst the radiation from standard EVAR is acceptable, more complicated and challenging EVARs, accompanied with additional radiological investigations and procedures, can significantly increase the radiation burden.
随着经验的增加，血管腔内主动脉瘤修复术（EVAR）已扩展至腹主动脉-髂动脉解剖结构不太合适的患者，以试图降低围手术期死亡率。然而，更复杂的EVAR手术可能耗时更长，并可能导致更高的并发症发生率、额外的介入手术以及更频繁的放射影像学检查，这可能会抵消部分益处。本研究确定了根据EVAR-1试验标准定义的标准EVAR以及更复杂EVAR的辐射负担。方法：共有123例年龄>60岁、动脉瘤>5.5 cm且接受分叉型覆膜支架植入的择期患者，根据是否符合严格的EVAR-1试验标准分组。计算每组的平均辐射剂量，以及EVAR术前和术后常规CT检查及EVAR术前髂动脉栓塞的额外辐射负担。结果：不符合EVAR-1试验标准的患者透视筛查时间显著更长，辐射剂量更高。所有患者在接受常规CT检查及EVAR术前髂动脉栓塞后辐射负担更高。结论：虽然标准EVAR的辐射是可接受的，但更复杂且具有挑战性的EVAR，伴随着额外的放射学检查和手术，会显著增加辐射负担。
