Maris Emma-Lena, Klaassen Jurre, Hazenberg Constantijn E V B, Petri Bart-Jeroen, Trimarchi Santi, van Herwaarden Joost A
Department of Vascular Surgery, Utrecht Medical Centre Utrecht, Utrecht, the Netherlands.
Department of Vascular Surgery, Utrecht Medical Centre Utrecht, Utrecht, the Netherlands.
J Vasc Surg. 2025 Aug 26. doi: 10.1016/j.jvs.2025.07.058.
Endovascular interventions have increasingly replaced open surgery owing to their minimally invasive nature and benefits such as faster recovery and fewer wound complications. This shift has led to greater reliance on fluoroscopy, raising concerns about occupational radiation exposure. Ionizing radiation, although essential for guiding procedures, can damage living tissue and potentially induce long-term health effects. Recent guidelines from the European Society for Vascular Surgery and the Cardiovascular and Interventional Radiological Society of Europe emphasize growing radiation risks and advocate for dose optimization and protective strategies. Endovascular specialists-vascular surgeons, interventional cardiologists, and radiologists-are among the most exposed hospital staff. Yet, limited studies have specifically examined the effects of fluoroscopy-induced DNA damage and carcinogenesis in these professionals. The aim of this systematic review was to evaluate the extent to which occupational radiation exposure contributes to DNA damage and cancer risk in endovascular operators.
A systematic search of the literature from 2000 to April 2025 of PubMed and EMBASE was conducted following the PRISMA guidelines. All experimental studies, observational studies, and case reports that examined DNA damage or cancer occurrence in operators performing endovascular procedures owing to occupational radiation exposure were included in this review. Studies were categorized into two primary outcomes: cancer and DNA damage. A risk of bias assessment was performed according to Cochrane guidelines.
Twenty-five studies were identified. The findings from these studies suggest that occupational radiation exposure in endovascular operators may lead to early-stage DNA damage shortly after exposure. Additionally, the studies observed chronic DNA damage, including double-strand DNA breaks and chromosomal aberrations, which are hypothesized to be a contributing factor to genomic instability and carcinogenesis. Furthermore, the studies researching carcinogenesis suggest an increased risk of cancer development in endovascular operators, with particular emphasis on cancer localizations that are more susceptible to radiation, such as leukemia and thyroid cancer, and in unprotected body areas, such as the skin and the brain.
This systematic review suggests that endovascular operators involved in fluoroscopy-guided interventional procedures may face an increased risk of stochastic health effects, with a particular emphasis on chronic DNA damage and carcinogenesis in locations more vulnerable to radiation. This review highlights the critical need for enhanced radiation safety measures, awareness, and preventative strategies.
血管内介入治疗因其微创性以及恢复更快、伤口并发症更少等优点，越来越多地取代了开放手术。这种转变导致对荧光透视的依赖增加，引发了对职业辐射暴露的担忧。电离辐射虽然对引导手术至关重要，但会损害活组织并可能导致长期健康影响。欧洲血管外科学会和欧洲心血管和介入放射学会的最新指南强调了不断增加的辐射风险，并提倡剂量优化和防护策略。血管内专家——血管外科医生、介入心脏病学家和放射科医生——是医院中受辐射暴露最多的工作人员之一。然而，仅有有限的研究专门考察了荧光透视引起的DNA损伤及其在这些专业人员中致癌的影响。本系统评价的目的是评估职业辐射暴露在多大程度上会导致血管内手术操作人员的DNA损伤和癌症风险。
按照PRISMA指南，对2000年至2025年4月PubMed和EMBASE数据库中的文献进行系统检索。所有研究职业辐射暴露导致血管内手术操作人员DNA损伤或癌症发生情况的实验研究、观察性研究和病例报告均纳入本评价。研究分为两个主要结果：癌症和DNA损伤。根据Cochrane指南进行偏倚风险评估。
共纳入25项研究。这些研究结果表明，血管内手术操作人员的职业辐射暴露可能在暴露后不久导致早期DNA损伤。此外，研究观察到慢性DNA损伤，包括双链DNA断裂和染色体畸变，据推测这是基因组不稳定和致癌的一个促成因素。此外，关于致癌作用的研究表明，血管内手术操作人员患癌症的风险增加，尤其强调更容易受辐射影响的癌症部位，如白血病和甲状腺癌，以及未受保护的身体部位，如皮肤和大脑。
本系统评价表明，参与荧光透视引导介入手术的血管内手术操作人员可能面临随机健康效应增加的风险，尤其强调在更易受辐射影响部位的慢性DNA损伤和致癌作用。本评价强调了加强辐射安全措施、提高意识和采取预防策略的迫切需求。
