St George's Vascular Institute, 4th Floor, St James Wing, St George's Healthcare NHS Trust, Blackshaw Road, London SW17 0QT, UK.
Eur J Vasc Endovasc Surg. 2012 Oct;44(4):395-8. doi: 10.1016/j.ejvs.2012.08.001. Epub 2012 Aug 22.
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.
血管内动脉瘤修复术（EVAR）的采用导致与腹主动脉瘤（AAA）修复相关的短期发病率和死亡率显著降低。然而，EVAR 可能会使患者和介入医生暴露于潜在的有害辐射水平，尤其是在进行更复杂的手术时。本研究旨在评估从放射技师控制的成像转变为操作员控制的成像（OCI）系统是否会影响 EVAR 期间的辐射暴露、筛查时间或对比剂量。
回顾性分析确定了在改变为操作员控制的成像之前或之后接受肾下 AAA 择期 EVAR 的患者。收集的数据包括辐射剂量（以剂量面积乘积；DAP）、筛查时间、总输送对比体积和手术持续时间。还收集了最大动脉瘤直径、患者年龄、性别和体重指数的数据。
在 2011 年 1 月至 2011 年 12 月期间，一家中心的 122 名患者接受了肾下 AAA 的 EVAR。其中 57 例在安装 OCI 之前，65 例在安装之后。安装 OCI 后 DAP 中位数明显低于安装前（4.9 mGy m²；范围 1.25-13.3）（p = 0.005）。安装 OCI 前后的筛查时间中位数分别为 20.0 分钟和 16.2 分钟（p = 0.027），而在 OCI 改变前后的对比体积中位数分别为 100 毫升和 90 毫升（p = 0.21）。
引入操作员控制的成像可以显著降低 EVAR 期间的辐射暴露，特别是降低“高剂量”病例的数量。
