Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece.
Department of Vascular Surgery, School of Medicine, University of Patras, Patras, Greece.
Radiat Prot Dosimetry. 2023 Apr 5;199(5):443-452. doi: 10.1093/rpd/ncad025.
Patients who undergo endovascular aortic aneurysm repair (EVAR) may require prolonged radiation exposure affected by several factors. The objectives of this study were to document fluoroscopy time (FT) during EVAR and identify possible factors that influence it. A retrospective analysis of a 180 patients' database with abdominal infrarenal aortic aneurysms submitted to EVAR during a 7-y period was performed. The FT is evaluated regarding risk factors and comorbidities, graft type and patient-related, clinical and technical parameters. FT's median (interquartile range) was 1011 (698-1500) s. Excluder and C3 Excluder were associated with significantly lower FT values when compared with other grafts. Hypertension, dyslipidemia, age ≥ 70 y, maximum aneurysm diameter ≥ 6 cm and procedure duration ≥2 h resulted in higher FT values. A significantly lower FT was found for the operations performed in the 7th y of the study's period compared with the previous 6 y, mainly because of the use of Excluder or C3 Excluder grafts. However, these grafts did not show any significant difference in FT values during the 7 y. A significant correlation between FT with age and procedure duration was found. Nevertheless, procedure duration is a poor FT predictor in linear and logistic regressions, although is significantly correlated with FT. Dyslipidemia, procedure duration and graft type are independent predictors of FT larger than the median, whereas only the procedure duration is a predictor for FT larger than the 75th percentile value. The identified factors regarding radiation protection issues should be considered when contemplating abdominal aortic aneurysm repair, however, without compromising the procedure's efficacy. Further work is necessary to identify more potential anatomical, clinical and technical factors affecting procedures' complexity and FT and patient radiation dose during EVAR interventions.
接受血管内主动脉瘤修复 (EVAR) 的患者可能需要长时间的辐射暴露，这受到多种因素的影响。本研究的目的是记录 EVAR 期间的透视时间 (FT)，并确定可能影响它的因素。对在 7 年内接受腹主动脉肾下型主动脉瘤 EVAR 的 180 例患者的数据库进行了回顾性分析。评估了 FT 与危险因素和合并症、移植物类型以及患者相关、临床和技术参数的关系。FT 的中位数（四分位数范围）为 1011（698-1500）s。与其他移植物相比，Excluder 和 C3 Excluder 与显著较低的 FT 值相关。高血压、血脂异常、年龄≥70 岁、最大动脉瘤直径≥6cm 和手术时间≥2h 导致 FT 值升高。与研究前 6 年相比，研究期间第 7 年的手术 FT 值显著降低，主要是由于使用了 Excluder 或 C3 Excluder 移植物。然而，这两种移植物在 7 年内的 FT 值没有显著差异。FT 与年龄和手术时间呈显著相关。然而，在线性和逻辑回归中，手术时间是 FT 的一个较差预测因子，尽管它与 FT 显著相关。血脂异常、手术时间和移植物类型是 FT 超过中位数的独立预测因子，而只有手术时间是 FT 超过第 75 百分位数值的预测因子。在考虑腹主动脉瘤修复时，应考虑与辐射防护相关的这些因素，但不应影响手术的疗效。需要进一步的工作来确定更多潜在的解剖、临床和技术因素，这些因素会影响手术的复杂性以及 EVAR 介入过程中的患者辐射剂量。
