Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Division of Medical Physics, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
J Vasc Surg. 2022 Aug;76(2):500-504. doi: 10.1016/j.jvs.2022.03.865. Epub 2022 Mar 31.
Radiation exposure and imaging quality are among the main concerns in endovascular procedures. The Clear VD11 PURE platform technology system (Siemens Healthineers, Erlangen, Germany) has been reported to lower the radiation dose and improve image quality. In the present study, we evaluated whether the radiation dose during peripheral arterial endovascular procedures had decreased after implementation of this new imaging system.
The patient characteristics (age, gender, body mass index [BMI]), procedure type (diagnostic, balloon angioplasty, atherectomy, stenting), body location (aortoiliac, superficial femoral artery, tibial artery), reference air kerma (RAK), kerma area product (KAP), and fluoroscopy time (FT) were recorded during peripheral artery interventions performed 1 year before (group A) and 1 year after (group B) the CLEAR system upgrade. The procedures were performed in an Artis zeego hybrid room (Siemens Healthineers) with the same providers. A general linear model was used to estimate the average difference between groups adjusted by procedure type and patient age, gender, and BMI. Additionally, to control for variations in case complexity, groups A and B were matched by age, gender, BMI, lesion location, and intervention type. Propensity score matching and a paired t test were used to compare the KAP, RAK, and FT stratified by single intervention procedures.
A total of 487 endovascular procedures were performed: 209 in group A and 278 in group B. A total of 111 single intervention procedures from each group were matched (1:1), with a mean age of 61 ± 8 years and a BMI of 26.5 ± 4 kg/m. The median KAP, RAK, and FT for group A were 28.8 Gy · cm (interquartile range [IQR], 24-34 Gy · cm), 146 mGy (IQR, 123-173 mGy), and 12 minutes (IQR, 10-14 minutes), respectively. The median KAP, RAK, and FT for group B were 18.3 Gy · cm (IQR, 16-22 Gy · cm), 71.2 mGy (IQR, 60-85 mGy), and 10.4 minutes (IQR, 9-12 minutes), respectively. The KAP, RAK, and FT were significantly decreased in group B by 24% (P = .005), 41% (P < .001), and 22% (P = .002), respectively, compared with the values for group A. Stratified by single intervention procedures, the KAP and RAK had decreased significantly in group B (36% [P = .002] and 51% [P < .001], respectively) compared with group A. The FT decrease of 13% in group B was not statistically significant (P = .20).
Use of the Clear VD11 PURE platform system (Siemens Healthineers) reduced the patient radiation dose by 51% during endovascular peripheral interventions. The similar FTs for the matched single intervention procedures before and after the upgrade indicated consistent case complexity and surgeon practice. This platform appears to be an effective system for lowering the radiation dose.
在血管内介入手术中，辐射暴露和成像质量是主要关注点之一。已报道 Clear VD11 PURE 平台技术系统（西门子医疗，德国埃尔朗根）可降低辐射剂量并提高图像质量。在本研究中，我们评估了在实施新成像系统后，外周动脉血管内介入手术中的辐射剂量是否降低。
记录了在 CLEAR 系统升级前 1 年（A 组）和升级后 1 年（B 组）进行的外周动脉介入治疗中患者的特征（年龄、性别、体重指数 [BMI]）、手术类型（诊断性、球囊血管成形术、旋切术、支架置入术）、身体位置（腹主动脉髂动脉、股浅动脉、胫动脉）、参考空气比释动能（RAK）、比释动能面积乘积（KAP）和透视时间（FT）。使用一般线性模型来估计调整手术类型和患者年龄、性别和 BMI 后两组之间的平均差异。此外，为了控制病例复杂性的变化，通过年龄、性别、BMI、病变位置和干预类型对 A 组和 B 组进行匹配。采用倾向评分匹配和配对 t 检验比较了按单一干预程序分层的 KAP、RAK 和 FT。
共进行了 487 例血管内手术：A 组 209 例，B 组 278 例。每组各有 111 例单一干预手术进行匹配（1:1），平均年龄 61±8 岁，BMI 为 26.5±4kg/m。A 组的中位数 KAP、RAK 和 FT 分别为 28.8Gy·cm（四分位距 [IQR]，24-34Gy·cm）、146mGy（IQR，123-173mGy）和 12 分钟（IQR，10-14 分钟）。B 组的中位数 KAP、RAK 和 FT 分别为 18.3Gy·cm（IQR，16-22Gy·cm）、71.2mGy（IQR，60-85mGy）和 10.4 分钟（IQR，9-12 分钟）。与 A 组相比，B 组的 KAP、RAK 和 FT 分别显著降低了 24%（P=0.005）、41%（P<0.001）和 22%（P=0.002）。按单一干预程序分层，B 组的 KAP 和 RAK 分别显著降低了 36%（P=0.002）和 51%（P<0.001），而 B 组的 FT 降低 13%则无统计学意义（P=0.20）。
在血管内外周介入治疗中，使用 Clear VD11 PURE 平台系统（西门子医疗）可将患者的辐射剂量降低 51%。升级前后匹配的单一干预程序的 FT 相似，表明手术难度和外科医生的操作保持一致。该平台似乎是降低辐射剂量的有效系统。
