Study Supports Team-Based Approach to Enhance Radiation Safety Profile of FEVAR

June 29, 2016—Alexander E. Rolls, MD, et al published a study demonstrating that implementation of a team-based approach to radiation reduction significantly reduces radiation dose during fenestrated endovascular aneurysm repair (FEVAR). These findings suggest that the radiation safety awareness that accompanies the introduction of fusion imaging may improve the overall radiation safety profile of FEVAR for patients and providers, concluded the investigators in the study available online ahead of print in the European Journal of Vascular and Endovascular Surgery (EJVES).

The investigators noted that FEVAR exposes operators and patients to considerable amounts of radiation. Introduction of fusion of three-dimensional CT with intraoperative fluoroscopy puts new focus on advanced imaging techniques in the operating environment and has been found to reduce radiation and facilitate faster repair. The aim of this study is to evaluate the radiation dose effect of introducing a team-based approach to complex aortic repair.

As summarized in EJVES, procedural details for a cohort of 21 patients undergoing FEVAR after fusion-guided (modern group) imaging was introduced are compared in the study with 21 patients treated in the immediate 12 months before implementation (historic group) at a center with expertise in FEVAR. Nonparametric tests were used to compare procedure time, air kerma, dose-area product (DAP), fluoroscopy time, estimated blood loss, and pre- and postoperative estimated glomerular filtration rate (eGFR) between the groups.

The investigators found that a change in operative approach resulted in a significant reduction in procedure time for the modern group (median, 285 min; interquartile range [IQR], 268–322) compared with the historic group (450 min; IQR, 360–540; P ≤ .001). There were reductions in skin dose for the modern group compared with the hstoric group (1.6 Gy; IQR, 1.09–2.1 vs 4.4 Gy; IQR, 3.2–7.05; P ≤ .001), as well as DAP (159 Gy.cm²; IQR, 123–226 vs 264.93 Gy.cm²; IQR, 173.3–366.8; P = .006). There were no significant differences in fluoroscopy time and pre- and postoperative eGFR between the two groups. Weight and height were distributed equally across both groups. Structured dose reports including the changes in frame rate were not available for analysis, reported the investigators EJVES.