Radiation doses in endovascular revascularisation of lower-extremity arterial diseases.

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.