CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 212 AFRICA Radiation doses in endovascular revascularisation of lower-extremity arterial diseases Ibrahim Çağrı Kaya, Fatma Altuntaş Kaya Abstract Background: The use of percutaneous endovascular intervention in lower-extremity arterial diseases is increasing daily. With the growing technical experience of vascular surgeons, this is preferred to open surgery in more complex lesions. Methods: The dose area product (DAP) and fluoro (FL) time values of 150 patients who underwent successful peripheral endovascular arterial intervention were analysed retrospectively. These values were evaluated by grouping according to the anatomical region and complexity of the lesion, type of procedure and arterial access. Results: While the mean DAP was 18 ± 27 Gy cm2 in patients who underwent only angioplasty, it was 21 ± 17 Gy cm2 in patients who underwent stent implantation after angioplasty (p = 0.069). The DAP value was statistically significantly higher in patients who had intervention in the pelvic region, both in the angioplasty (23 ± 22 Gy cm2) group and in the stenting (29 ± 18 Gy cm2) group, than in patients who had intervention in the femoropopliteal region (18 ± 27 and 15 ± 12 Gy cm2, respectively) (p < 0.05). When the correlation between body mass index (BMI) of the patients and DAP was examined, a moderate positive correlation was found both in the pelvic region (r = 0.601, p = 0.00) and in the femoropopliteal region (r = 0.512, p = 0.00). Out of 78 patients in whom the ipsilateral popliteal retrograde approach was preferred, only two developed arteriovenous fistulae after the procedure, and only two of 77 patients in whom the femoral approach was preferred developed no major or minor complications, except femoral pseudo-aneurysm. Conclusions: The most important factors affecting the radiation doses of the patients were the anatomical region and the patient’s BMI. Radiation doses were higher in pelvic interventions compared to the femoropopliteal region. This may encourage the choice of arterial approaches that can minimise visualisation of the pelvic region in particular. Therefore, attention should be paid to pre-operative planning, especially in patients undergoing multiple diagnostic and therapeutic imaging. The ipsilateral popliteal retrograde approach can be safely chosen in combined iliofemoral, common femoral and superficial femoral total occlusions in the hands of surgeons with good Doppler ultrasonography experience. Keywords: endovascular revascularisation, peripheral arterial disease, radiation exposure Submitted 14/5/21; accepted 19/8/22 Published online 23/9/22 Cardiovasc J Afr 2023; 34: 212–216 www.cvja.co.za DOI: 10.5830/CVJA-2022-046 Percutaneous endovascular revascularisation interventions are widely used in increasingly complex cases of lower-extremity arterial disease (LEAD). Particularly in our country, the increasing experience and success rates over time of vascular surgeons in endovascular interventions have led to fewer open surgical procedures for the lower extremities. This has increased the number of studies conducted, which report fewer complications, lower radiation doses and higher success rates.1 Factors such as the complexity of the lesion, its anatomical location and vascular structure can affect selection of the arterial access site to reach the lesion. Patient and operator radiation doses are undoubtedly very important in this selection. Monitoring patients’ exposure to X-rays is crucial to minimising the harmful effects of radiation and is an integral part of monitoring the quality of work in interventional units.2 The values most commonly used in studies of patients’ radiation doses are fluoroscopy (FL) time and dose area product (DAP), defined as the radiation dose absorbed multiplied by the irradiated area and expressed as gray square centimetres (Gy cm2). It has been suggested that DAP is the most effective value in predicting the risk of malignancy due to radiation, therefore it can be used to predict harmful effects. It can also be used to compare doses between different types of procedures in the same anatomical region and between the same procedures in different centres.3 The aim of this study was to retrospectively evaluate the radiation exposure of patients during endovascular revascularisation in a single tertiary medical centre, according to the anatomical region, type of intervention, procedure performed and the complexity of arterial lesions. Methods We retrospectively analysed the data regarding peripheral endovascular revascularisation interventions performed between December 2018 and November 2020, in patients with symptomatic peripheral arterial disease, intermittent claudication and critical leg ischaemia, by the cardiovascular surgery clinic of Eskişehir City Hospital. While patients who underwent arterial revascularisation were included in the study, patients whose arterial system could not be accessed or the lesion could not be passed were excluded from the study. Patients’ data were retrieved from the electronic hospital medical record system, the imaging archiving and communication system and the angiography X-ray system. Since this was a Eskisehir City Hospital, Eskisehir, Turkey Ibrahim Çağrı Kaya, MD, icagrikaya@gmail.com Department of Neurology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey Fatma Altuntaş Kaya, MD
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