Academic Department of Vascular Surgery, School of Cardiovascular Medicine and Sciences, King's College London, United Kingdom; BHF Centre of Excellence, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom.
Department of Interventional Radiology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom.
J Vasc Surg Venous Lymphat Disord. 2020 Mar;8(2):259-267. doi: 10.1016/j.jvsv.2019.03.018. Epub 2019 Jun 24.
The study aimed to assess the cumulative radiation exposure from preoperative, periprocedural, and follow-up imaging to patients who underwent common endovascular deep venous interventions for acute and chronic central venous outflow obstructive diseases; namely, deep vein thrombosis (DVT) thrombolysis, unilateral chronic iliofemoral venous stenting, and inferior vena cava (IVC) reconstruction in a single center.
Patients who had DVT thrombolysis of upper extremity (UE) DVT and lower extremity (LE) DVT, unilateral chronic iliofemoral venous stenting, and endovascular IVC reconstruction between May 1, 2012, and July 31, 2017, in a single unit were retrospectively reviewed. Demographic data, anatomic DVT, imaging, technical details of the index procedure, follow-up, and radiation exposure measured in dose-length product, dose-area product (DAP), and fluoroscopy time (FT) from related computed tomography scans and interventions were analyzed. Mann-Whitney U tests were performed to assess for significance of differences between subgroups. A P value of less than .05 was considered significant.
In total, 20 UE DVT thrombolysis, 91 LE DVT thrombolysis, 56 unilateral chronic iliofemoral venous stenting, and 39 endovascular IVC reconstruction patients were included in the study, with the following median ages: 39 years (range, 20-67 years), 44 years (range, 15-78 years), 45 years (range, 20-80 years), and 35 years (range, 18 -73 years), respectively. The median cumulative DAP for the index DVT thrombolysis was 9.2 Gycm (range, 0.2-176.0 Gycm) for LE DVT and 2.0 Gycm (range, 0.1-11.7 Gycm) for UE DVT (P < .0001). The median cumulative FT for the index thrombolysis was 981 seconds (range, 20-4890 seconds) and 837 seconds (range, 19-2895 seconds) for LE DVT and UE DVT, respectively (P = .18). For unilateral chronic iliofemoral venous stenting, the median cumulative DAP and FT were 32.4 Gycm (range, 0.1-289.6 Gycm) and 660 seconds (range, 246-4200 seconds), respectively. Meanwhile, the median cumulative DAP and FT for the endovascular IVC reconstruction were 60.8 Gycm (range, 2.5-269.1 Gycm) and 2846 seconds (range, 836-11682 seconds), respectively. The median DAP for secondary procedures during follow-up was 6.6 Gycm (range, 0.8 186.5 Gycm), 1.9 Gycm (range, 0.2-111.7 Gycm), and 24.3 Gycm (range, 0.2-157.5 Gycm) for LE DVT thrombolysis, unilateral chronic iliofemoral venous stenting, and endovascular IVC reconstruction, respectively.
Patient radiation exposure for endovascular deep venous interventions for central venous outflow obstruction measured in DAP and FT seemed to be less than and at most similar to anatomically comparable arterial interventions in the literature. However, these patients were usually much younger than those with arterial diseases and may need secondary interventions involving further radiation exposure in their lifetime.
本研究旨在评估在单个中心接受常见的血管内深静脉介入治疗急性和慢性中心静脉流出阻塞性疾病（即上肢深静脉血栓形成[DVT]溶栓、单侧慢性髂股静脉支架置入和下腔静脉[IVC]重建）的患者的术前、围手术期和随访影像学检查的累积辐射暴露。
回顾性分析 2012 年 5 月 1 日至 2017 年 7 月 31 日期间在单个单位接受上肢 DVT 和下肢 DVT 溶栓、单侧慢性髂股静脉支架置入和血管内 IVC 重建的患者。分析人口统计学数据、解剖 DVT、影像学检查、指数手术的技术细节、随访和相关 CT 扫描和介入的剂量长度产品、剂量面积乘积（DAP）和透视时间（FT）的辐射暴露。采用 Mann-Whitney U 检验评估亚组之间的差异是否有统计学意义。P 值小于.05 被认为有统计学意义。
共有 20 例上肢 DVT 溶栓、91 例下肢 DVT 溶栓、56 例单侧慢性髂股静脉支架置入和 39 例血管内 IVC 重建患者纳入研究，其年龄中位数分别为 39 岁（范围，20-67 岁）、44 岁（范围，15-78 岁）、45 岁（范围，20-80 岁）和 35 岁（范围，18-73 岁）。下肢 DVT 溶栓的指数 DVT 溶栓的中位 DAP 为 9.2 Gycm（范围，0.2-176.0 Gycm），上肢 DVT 为 2.0 Gycm（范围，0.1-11.7 Gycm）（P<.0001）。下肢 DVT 和上肢 DVT 的指数溶栓的中位 FT 分别为 981 秒（范围，20-4890 秒）和 837 秒（范围，19-2895 秒）（P=.18）。单侧慢性髂股静脉支架置入的中位 DAP 和 FT 分别为 32.4 Gycm（范围，0.1-289.6 Gycm）和 660 秒（范围，246-4200 秒）。同时，血管内 IVC 重建的中位 DAP 和 FT 分别为 60.8 Gycm（范围，2.5-269.1 Gycm）和 2846 秒（范围，836-11682 秒）。随访期间的二级手术的中位 DAP 分别为下肢 DVT 溶栓、单侧慢性髂股静脉支架置入和血管内 IVC 重建的 6.6 Gycm（范围，0.8-186.5 Gycm）、1.9 Gycm（范围，0.2-111.7 Gycm）和 24.3 Gycm（范围，0.2-157.5 Gycm）。
以 DAP 和 FT 衡量的血管内深静脉介入治疗中心静脉流出阻塞的患者的辐射暴露似乎低于文献中解剖学可比的动脉介入，并且最多与之相似。然而，这些患者通常比患有动脉疾病的患者年轻得多，他们可能需要在其一生中进行涉及进一步辐射暴露的二次干预。
