Radiation Dose Reduction During EVAR: Results from a Prospective Multicentre Study (The REVAR Study). (September 2018)

• Record Type: Journal Article
• Authors: Hertault, Adrien; Rhee, Robert; Antoniou, George A.; Adam, Donald; Tonda, Hisashi; Rousseau, Hervé; Bianchini, Aurélia; Haulon, Stéphan
• Is Part Of: European journal of vascular and endovascular surgery. Volume 56:Number 3(2018)
• Page Start: 426
• Page End: 433
• Publication Date: 2018-09
• Subjects: Radiation -- Endograft -- Fusion imaging -- Hybrid room -- Aortic aneurysm -- Dose archiving system; Blood-vessels -- Endoscopic surgery -- Periodicals; Blood-vessels -- Surgery -- Periodicals; Vascular Surgical Procedures -- Periodicals; Vascular Surgical Procedures -- methods -- Periodicals; Vaisseaux sanguins -- Chirurgie -- Périodiques; Vaisseaux sanguins -- Chirurgie endoscopique -- Périodiques; Blood-vessels -- Endoscopic surgery; Blood-vessels -- Surgery; Endoscopy; Electronic journals; Periodicals; Electronic journals; 617.413005
• DOI: 10.1016/j.ejvs.2018.05.001
• Languages: English
• ISSNs: 1078-5884

Abstract

Abstract : Objective: To evaluate radiation exposure in standard endovascular aneurysm repair (EVAR) using intra-operative guidance with pre-operative computed tomographic angiography (CTA) fusion and strict ALARA guidelines in a modern hybrid room. Material and methods: Between February and November 2016, consecutive patients with AAA undergoing EVAR with a bifurcated device in a hybrid room under fusion imaging guidance were prospectively enrolled in six aortic centres from the United States ( n = 1), Europe ( n = 4), and Japan ( n = 1). Demographic data including body mass index (BMI), indirect dose area product (DAP), cumulative air kerma (CAK), variables influencing dose delivery, and contrast media volume were collected. Results: 85 patients (90.4% males) were included. The median age was 75 (IQR 69–81), with a median BMI of 27.4 (IQR 24.7–30.6). Median DAP and CAK were 14.7 (IQR 10.0–27.7) Gy·cm 2 and 107 (IQR 68.0–189.0) mGy, respectively. The median contrast volume was 47 mL (IQR 35–70) (equivalent to 14.1g of iodine [IQR 10.5–21.0]). Median DAP per centre was 28.1 ( n = 16, IQR 12.6–47.1), 15.9 ( n = 11, IQR 11.9–22.5), 14.2 ( n = 12, IQR 10.9–25.7), 20.2 ( n = 18, IQR 7.0–39.5), 10.3 ( n = 27, IQR 8.2–14.7) and 26.5 ( n = 1) Gy·cm 2 . In multivariable analysis, collimation was the only factor that was significantly associated with DAP reduction, (coefficient = −0.014 per percentage of collimation, 95% CI −0.019 to −0.008, p < .001). Conclusions: With adherence to the ALARA principle and routine application of fusion imaging guidance for EVAR, low radiation exposure compared with the published literature can be achieved in a real world setting.