Monastiriotis Spyridon, Comito Matthew, Labropoulos Nicos
Department of Vascular Surgery, Stony Brook University Hospital, Stony Brook, NY.
Department of Vascular Surgery, Stony Brook University Hospital, Stony Brook, NY.
J Vasc Surg. 2015 Sep;62(3):753-61. doi: 10.1016/j.jvs.2015.05.033. Epub 2015 Jul 10.
Endovascular aortic repair has become increasingly popular the last years for the treatment of abdominal aortic aneurysms (EVAR) and thoracic aortic aneurysms. EVAR is less invasive compared with the classic open approach, related to a decreased immediate postoperative morbidity and mortality. Those beneficial characteristics of EVAR do not come without a cost, since EVAR requires that the patient will be exposed to a significant amount of radiation during preoperative planning, graft placement, and consecutive follow-up. This systematic review examines the periprocedural radiation exposure to patients and staff as well as ways to ameliorate it.
A systematic literature search was conducted using the MEDLINE electronic database. All articles reporting radiation exposure to alive humans during EVAR were eligible for review. Only studies publishing numerical data regarding radiation exposure were included in the Results section. Other relevant articles were used for further discussion.
Twenty-four studies, both prospective and retrospective in nature, were included. These studies revealed that the radiation exposure depends on the specific type of procedure, with more complex procedures carrying greater radiation burden. Variations in the positioning and operating of the fluoroscopic unit may significantly alter radiation dose to both patients and staff. There was an apparent lack of education among vascular specialists and trainees in terms of radiation safety awareness. At follow-up, a significant number of patients needed additional procedures, and all required radiographic imaging, further increasing the radiation exposure to alarming levels.
Every effort should be made to decrease radiation exposure related to endovascular aortic procedures. Attempts must be directed towards maximizing the operator's awareness, welcoming new imaging technology emitting less radiation, and shifting to follow-up strategies that require minimal or no radiation.
在过去几年中，血管内主动脉修复术已越来越广泛地用于治疗腹主动脉瘤（EVAR）和胸主动脉瘤。与传统的开放手术相比，EVAR的侵入性较小，术后即刻的发病率和死亡率也较低。然而，EVAR的这些有益特性并非没有代价，因为在术前规划、移植物放置和后续随访过程中，患者需要接受大量辐射。本系统评价旨在研究围手术期患者和工作人员的辐射暴露情况以及改善措施。
使用MEDLINE电子数据库进行系统的文献检索。所有报道EVAR期间活体人类辐射暴露的文章均符合纳入标准。结果部分仅纳入发表了辐射暴露数值数据的研究。其他相关文章用于进一步讨论。
共纳入24项前瞻性和回顾性研究。这些研究表明，辐射暴露取决于具体的手术类型，手术越复杂，辐射负担越大。荧光透视设备的定位和操作差异可能会显著改变患者和工作人员所接受的辐射剂量。血管外科专家和实习生在辐射安全意识方面明显缺乏培训。在随访过程中，大量患者需要额外的手术，且均需进行影像学检查，这进一步将辐射暴露增加到了令人担忧之水平。
应尽一切努力减少与血管内主动脉手术相关的辐射暴露。必须致力于提高操作人员的意识，采用辐射较少的新型成像技术，并转向辐射最少或无需辐射的随访策略。
