Martínez Lucia I, Esteban Carlos, Riera Clàudia, Altés Pere, Llagostera Secundino
Vascular Surgery Department, Hospital Germans Trias i Pujol, Barcelona, Spain.
Vascular Surgery Department, Hospital Germans Trias i Pujol, Barcelona, Spain.
Ann Vasc Surg. 2020 Nov;69:366-372. doi: 10.1016/j.avsg.2020.05.065. Epub 2020 Jun 3.
To compare contrast usage and radiation exposure during endovascular aneurysm repair (EVAR) using mobile C-arm imaging in a conventional operating room (OR) or fixed angiographic equipment in a hybrid OR (HR).
A retrospective unicenter study from May 2016 to August 2019. All consecutive patients undergoing standard EVAR were included. Patients were divided into 2 groups. Group OR included EVARs performed in a conventional OR with a mobile C-arm (May 2016 to April 2018) and group HR included EVARs performed with a fixed angiographic equipment in an HR (May 2018 to August 2019). Data collected included patient demographics, aneurysm diameter, neck length, radiation dose: median dose-area product (DAP), fluoroscopy time, total operative time, contrast use, and 30-day clinical outcomes.
A total of 77 patients were included in the study (42 patients in group OR and 35 patients in group HR). There was no difference in age, body mass index (BMI), mean aneurysm, and neck length between groups. Patients in the group HR received less contrast volume (108.6 mL [±41.5] vs. 162.5 mL [±52.6]; P < 0.001), but higher radiation dose (154 Gy cm [±102.9] vs. 61.5 Gy cm [±42.4]; P < 0.001). There were no differences in fluoroscopy time (20.4 min [±8.5] vs. 23.2 min [±12.4]; P = 0.274) and total operative time (106.4 [±22.3] vs. 109.4 [±25.8]; P = 0.798). No difference was found in terms of 30-day complication rates or operative mortality between groups. DAP was positively correlated with BMI in the group OR (Spearman's rank correlation coefficient r, 0.580; P < 0.001), but no correlation could be seen in the group HR (r, 0.408; P = 0.028).
Routine EVAR performed in a hybrid fixed-imaging suite may be associated with less contrast usage, but higher radiation exposure in our center. The significantly higher radiation exposure when the mobile C-arm is replaced by an HR should not be underestimated.
比较在传统手术室（OR）中使用移动C形臂成像与在杂交手术室（HR）中使用固定血管造影设备进行血管内动脉瘤修复（EVAR）期间的造影剂使用情况和辐射暴露。
一项2016年5月至2019年8月的回顾性单中心研究。纳入所有接受标准EVAR的连续患者。患者分为两组。OR组包括在传统手术室中使用移动C形臂进行的EVAR（2016年5月至2018年4月），HR组包括在杂交手术室中使用固定血管造影设备进行的EVAR（2018年5月至2019年8月）。收集的数据包括患者人口统计学资料、动脉瘤直径、颈部长度、辐射剂量：中位剂量面积乘积（DAP）、透视时间、总手术时间、造影剂使用量以及30天临床结局。
本研究共纳入77例患者（OR组42例，HR组35例）。两组患者在年龄、体重指数（BMI）、平均动脉瘤大小和颈部长度方面无差异。HR组患者的造影剂使用量较少（108.6 mL[±41.5]对162.5 mL[±52.6]；P<0.001），但辐射剂量较高（154 Gy cm[±102.9]对61.5 Gy cm[±42.4]；P<0.001）。透视时间（20.4分钟[±8.5]对23.2分钟[±12.4]；P=0.274）和总手术时间（106.4[±22.3]对109.4[±25.8]；P=0.798）无差异。两组在30天并发症发生率或手术死亡率方面无差异。在OR组中，DAP与BMI呈正相关（Spearman等级相关系数r，0.580；P<\u200b0.001），但在HR组中未观察到相关性（r，0.408；P=0.028）。
在我们中心，在杂交固定成像设备中进行的常规EVAR可能造影剂使用量较少，但辐射暴露较高。当移动C形臂被杂交手术室取代时，显著更高的辐射暴露不应被低估。
