Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
Department of Cardiovascular Research, St. Luke's Mid America Heart Institute, Kansas City, Missouri.
JACC Cardiovasc Interv. 2019 Mar 11;12(5):473-480. doi: 10.1016/j.jcin.2018.11.005.
The aims of this study were to determine the incidence of actionably high radiation dosages and to identify predictors of increased patient dosage.
Peripheral endovascular intervention using fluoroscopic imaging has become a mainstay of treatment for lower extremity peripheral artery disease but exposes patients to ionizing radiation.
Patient radiation dosage, quantified as dose-area product (DAP), was obtained from the National Cardiovascular Data Registry Peripheral Vascular Intervention Registry. The percentage of procedures exceeding a DAP of 500 Gy · cm, the threshold above which follow-up for radiation-related adverse effects is indicated by the National Council on Radiation Protection and Measurements, was determined. A multivariate regression model was generated to identify patient and procedural factors associated with increasing DAP.
Among 17,174 procedures performed at 73 sites, patient DAP exceeded 500 Gy · cm in 7%. Independent predictors of increased patient DAP in order from greatest magnitude of effect included more proximal lesion location, bifurcation lesion, male sex, diabetes, hypertension, prior percutaneous coronary intervention, increasing lesion length, and increasing body mass index; antegrade vascular access, critical limb ischemia, and increasing age predicted decreased DAP.
Radiation dosage with the potential for tissue injury occurs in 1 of every 14 patients undergoing lower extremity endovascular interventions, and all such patients are exposed to the potential for subsequent malignancy. Pre-procedural assessment of patients' risk for elevated radiation dosage may allow targeted use of radiation mitigation strategies in patients at increased risk for elevated exposure.
本研究旨在确定可采取行动的高辐射剂量的发生率，并确定增加患者剂量的预测因素。
使用荧光透视成像的外周血管腔内介入治疗已成为下肢外周动脉疾病治疗的主要手段，但会使患者暴露于电离辐射下。
从国家心血管数据登记处外周血管介入登记处获得患者的辐射剂量，以剂量面积乘积（DAP）表示。确定超过 500Gy·cm 的 DAP 百分比，这是美国国家辐射防护与测量委员会表示需要随访辐射相关不良反应的阈值。生成多变量回归模型以确定与增加 DAP 相关的患者和程序因素。
在 73 个部位进行的 17174 例手术中，有 7%的患者 DAP 超过 500Gy·cm。按影响程度从大到小排列，患者 DAP 增加的独立预测因素包括病变位置更靠近近端、分叉病变、男性、糖尿病、高血压、既往经皮冠状动脉介入治疗、病变长度增加和体重指数增加；顺行血管入路、严重肢体缺血和年龄增加预测 DAP 降低。
每 14 例接受下肢血管腔内介入治疗的患者中就有 1 例发生有潜在组织损伤风险的辐射剂量，所有此类患者都有发生后续恶性肿瘤的风险。在术前评估患者的辐射剂量升高风险，可能使具有升高暴露风险的患者能够针对性地使用辐射缓解策略。
