Prospective Assessment of Direct Measurements of Absorbed Radiation Exposure in Operators and Patients Undergoing Fenestrated and Branched Endovascular Aortic Repair

Abstract

To analyze the direct dose of absorbed radiation exposure of the primary operator and the patient during fenestrated-branched endovascular aortic repair (FB-EVAR) of complex abdominal (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs). Patients treated by FB-EVAR for CAAAs and TAAAs were prospectively enrolled between March and December 2022. Measurements of direct dose of absorbed radiation exposure were obtained using nanodots sensors (Landauer Inc., Glenwood, IL) positioned in standard location within unprotected skin area of the primary operator and patient face and periorbital area. The primary operator was positioned in the right femoral access site. Measurements of direct dose of absorbed radiation exposure (mGy) were compared with recorded metrics of the imaging unit including total radiation dose (mGy), dose area product (DAP) (mGy·cm2) and fluoroscopy time (minutes). There were 48 patients (75% male; mean age, 73 ± 9 years) enrolled in the study and treated by FB-EVAR for TAAAs in 38 patients (79%), CAAAs in 8 (17%), and arch aneurysms in 2 (4%). As shown in the Figure, measurements of DDRAE was three-fold higher for the patient compared to the primary operator (0.34 ± 0.27 vs 0.09 ± 0.06 mGy; P < .001). The left side of the primary operator face and periorbital artery was exposed to five-fold higher DDRAE compared to the right side (0.16 ± 0.12 vs 0.03 ± 0.004 mGy; P < .001). For the patient, the left side was exposed to significantly higher DDRAE as compared to the right side (0.42 ± 0.34 vs 0.32 ± 0.33 mGy; P < .001). All three recorded metrics (total radiation dose, DAP, and fluoroscopy time) had significant linear correlation with DDRAE measurements for the primary operator (P < .001). However, for the patient a linear correlation with DDRAE measurements was observed only for fluoroscopy time (P = .002) and not for total radiation dose (P = .28) or DAP (P = .49). Patients treated by FB-EVAR have on average five-fold higher dose of absorbed radiation in the unprotected face and periorbital areas as compared to their primary operators, with significantly higher doses in their left side as compared to the right side. For the primary operator, the left side of the face and periorbital area are exposed to three-fold more absorbed radiation that the right side. When compared to metrics provided by the imaging unit, measurements of DDRAE had linear correlation with fluoroscopy time, total radiation exposure and DAP for the primary operator, but only fluoroscopy time for the patient.