National Diagnostic Reference Levels for Endovascular Aneurysm Repair in Sweden

IF 8.5 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery Pub Date : 2026-10-01 Epub Date: 2026-03-14 DOI:10.1016/j.ejvs.2026.03.009

Erna Markusdottir, Alice Lindén, Catharina Cicek, Joachim Starck, Kristian Smidfelt, Magnus Jonsson, Mari Holsti, Sofia Strömberg, Sara Bruce, Talha Butt, Kevin Mani

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The aim of this study was to propose a national DRL for Sweden for standard endovascular aortic repair (EVAR).</div></div><div>The 2023 European Society for Vascular Surgery (ESVS) guidelines on radiation safety recommended establishment of national diagnostic reference levels (DRLs) for endovascular procedures, which indicate an expected radiation dose for any given procedure for the average sized patient. The aim of this study was to propose a national DRL for Sweden for standard endovascular aortic repair (EVAR).</div><div><h3>Methods</h3><div>This was a national registry based study where all EVARs performed in Sweden over a two year period (2021 – 2022) were identified in the Swedish vascular registry, Swedvasc. Patient demographics were extracted from Swedvasc and radiation related parameters were collected at centre level. Multivariable analyses were performed to assess which factors affected fluoroscopy time, total dose area product (DAP), and cumulative air kerma (CAK). 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The median (interquartile range [IQR]) DAP for EVAR at centre level varied from 28.3 Gy·cm<sup>2</sup> (IQR 14.1, 76.1) to 212.7 Gy·cm<sup>2</sup> (IQR 196.8, 275.0). Overall, the third quartile of the DAP radiation dose for EVAR in Sweden was 152.6 Gy·cm<sup>2</sup>. The DAP was a median 81.1 Gy·cm<sup>2</sup> and 116.5 Gy·cm<sup>2</sup> for intact and ruptured EVARs, respectively (<em>p</em> < .001). The DRL was 147.7 Gy·cm<sup>2</sup> and 213.8 Gy·cm<sup>2</sup> for intact and ruptured EVARs, respectively. In a multivariable linear regression analysis, rupture, iliac branched repair, access complication, obesity, low centre volume and larger aneurysm were predictors for higher DAP during EVAR.</div></div><div>Nine hundred and thirty-three procedures at 23 centres were included; 831 (89.1%) intact abdominal aortic aneurysms (AAAs) and 102 (10.9%) ruptured AAAs. The median (interquartile range [IQR]) DAP for EVAR at centre level varied from 28.3 Gy·cm<sup>2</sup> (IQR 14.1, 76.1) to 212.7 Gy·cm<sup>2</sup> (IQR 196.8, 275.0). Overall, the third quartile of the DAP radiation dose for EVAR in Sweden was 152.6 Gy·cm<sup>2</sup>. The DAP was a median 81.1 Gy·cm<sup>2</sup> and 116.5 Gy·cm<sup>2</sup> for intact and ruptured EVARs, respectively (<em>p</em> < .001). The DRL was 147.7 Gy·cm<sup>2</sup> and 213.8 Gy·cm<sup>2</sup> for intact and ruptured EVARs, respectively. In a multivariable linear regression analysis, rupture, iliac branched repair, access complication, obesity, low centre volume and larger aneurysm were predictors for higher DAP during EVAR.</div><div><h3>Conclusion</h3><div>The current report proposes a DRL for DAP of 152.6 Gy·cm<sup>2</sup> for EVAR procedures in Sweden, with specific benchmark DAP values proposed for subgroups of patients. 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引用次数: 0

Abstract

Objective

The 2023 European Society for Vascular Surgery (ESVS) guidelines on radiation safety recommended establishment of national diagnostic reference levels (DRLs) for endovascular procedures, which indicate an expected radiation dose for any given procedure for the average sized patient. The aim of this study was to propose a national DRL for Sweden for standard endovascular aortic repair (EVAR).

Methods

This was a national registry based study where all EVARs performed in Sweden over a two year period (2021 – 2022) were identified in the Swedish vascular registry, Swedvasc. Patient demographics were extracted from Swedvasc and radiation related parameters were collected at centre level. Multivariable analyses were performed to assess which factors affected fluoroscopy time, total dose area product (DAP), and cumulative air kerma (CAK). The national DRL was defined as the third quartile of all centre specific median values for DAP total.

Results

Nine hundred and thirty-three procedures at 23 centres were included; 831 (89.1%) intact abdominal aortic aneurysms (AAAs) and 102 (10.9%) ruptured AAAs. The median (interquartile range [IQR]) DAP for EVAR at centre level varied from 28.3 Gy·cm² (IQR 14.1, 76.1) to 212.7 Gy·cm² (IQR 196.8, 275.0). Overall, the third quartile of the DAP radiation dose for EVAR in Sweden was 152.6 Gy·cm². The DAP was a median 81.1 Gy·cm² and 116.5 Gy·cm² for intact and ruptured EVARs, respectively (p < .001). The DRL was 147.7 Gy·cm² and 213.8 Gy·cm² for intact and ruptured EVARs, respectively. In a multivariable linear regression analysis, rupture, iliac branched repair, access complication, obesity, low centre volume and larger aneurysm were predictors for higher DAP during EVAR.

Conclusion

The current report proposes a DRL for DAP of 152.6 Gy·cm² for EVAR procedures in Sweden, with specific benchmark DAP values proposed for subgroups of patients. There is a considerable difference in radiation dose between different centres, suggesting a potential for implementation of improved radiation routines in some centres based on benchmarking.

查看原文本刊更多论文

瑞典血管内动脉瘤修复的国家诊断参考水平。

目的：2023年欧洲血管外科学会（ESVS）关于辐射安全的指南建议为血管内手术建立国家诊断参考水平（DRLs），这表明了平均体型患者任何给定手术的预期辐射剂量。本研究的目的是为瑞典提出标准血管内主动脉修复（EVAR）的国家DRL。方法：这是一项基于国家登记的研究，在瑞典血管登记处Swedvasc中确定了2年期间（2021 - 2022）在瑞典进行的所有EVARs。从Swedvasc中提取患者人口统计数据，并收集中心水平的辐射相关参数。采用多变量分析来评估影响透视时间、总剂量面积积（DAP）和累积空气kerma （CAK）的因素。国家DRL被定义为DAP总量的所有中心特定中位数的第三个四分位数。结果：共纳入23个中心的933例手术；完整腹主动脉瘤831例（89.1%），破裂腹主动脉瘤102例（10.9%）。中心水平EVAR的中位数（四分位间距[IQR]） DAP从28.3 Gy·cm2 （IQR 14.1, 76.0）到212.7 Gy·cm2 （IQR 196.8, 275.0）不等。总体而言，瑞典EVAR的DAP辐射剂量的第三四分位数为152.6 Gy·cm2。完整和破裂EVARs的DAP中位数分别为81.1 Gy·cm2和116.5 Gy·cm2（完整和破裂EVARs的DAP中位数分别为213.8 Gy·cm2和213.8 Gy·cm2）。在多变量线性回归分析中，破裂、髂分支修复、通路并发症、肥胖、低中心容积、较大的动脉瘤和颈直径是EVAR期间较高DAP的预测因素。结论：目前的报告建议瑞典EVAR手术的DAP的DRL为152.6 Gy·cm2，并为患者亚组提出了特定的基准DAP值。不同中心之间的辐射剂量有相当大的差异，这表明在一些中心有可能根据基准执行改进的辐射程序。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.