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Patient radiation exposure for endovascular deep venous interventions.
- Source :
-
Journal of vascular surgery. Venous and lymphatic disorders [J Vasc Surg Venous Lymphat Disord] 2020 Mar; Vol. 8 (2), pp. 259-267. Date of Electronic Publication: 2019 Jun 24. - Publication Year :
- 2020
-
Abstract
- Objective: The study aimed to assess the cumulative radiation exposure from preoperative, periprocedural, and follow-up imaging to patients who underwent common endovascular deep venous interventions for acute and chronic central venous outflow obstructive diseases; namely, deep vein thrombosis (DVT) thrombolysis, unilateral chronic iliofemoral venous stenting, and inferior vena cava (IVC) reconstruction in a single center.<br />Methods: Patients who had DVT thrombolysis of upper extremity (UE) DVT and lower extremity (LE) DVT, unilateral chronic iliofemoral venous stenting, and endovascular IVC reconstruction between May 1, 2012, and July 31, 2017, in a single unit were retrospectively reviewed. Demographic data, anatomic DVT, imaging, technical details of the index procedure, follow-up, and radiation exposure measured in dose-length product, dose-area product (DAP), and fluoroscopy time (FT) from related computed tomography scans and interventions were analyzed. Mann-Whitney U tests were performed to assess for significance of differences between subgroups. A P value of less than .05 was considered significant.<br />Results: In total, 20 UE DVT thrombolysis, 91 LE DVT thrombolysis, 56 unilateral chronic iliofemoral venous stenting, and 39 endovascular IVC reconstruction patients were included in the study, with the following median ages: 39 years (range, 20-67 years), 44 years (range, 15-78 years), 45 years (range, 20-80 years), and 35 years (range, 18 -73 years), respectively. The median cumulative DAP for the index DVT thrombolysis was 9.2 Gycm <superscript>2</superscript> (range, 0.2-176.0 Gycm <superscript>2</superscript> ) for LE DVT and 2.0 Gycm <superscript>2</superscript> (range, 0.1-11.7 Gycm <superscript>2</superscript> ) for UE DVT (P < .0001). The median cumulative FT for the index thrombolysis was 981 seconds (range, 20-4890 seconds) and 837 seconds (range, 19-2895 seconds) for LE DVT and UE DVT, respectively (P = .18). For unilateral chronic iliofemoral venous stenting, the median cumulative DAP and FT were 32.4 Gycm <superscript>2</superscript> (range, 0.1-289.6 Gycm <superscript>2</superscript> ) and 660 seconds (range, 246-4200 seconds), respectively. Meanwhile, the median cumulative DAP and FT for the endovascular IVC reconstruction were 60.8 Gycm <superscript>2</superscript> (range, 2.5-269.1 Gycm <superscript>2</superscript> ) and 2846 seconds (range, 836-11682 seconds), respectively. The median DAP for secondary procedures during follow-up was 6.6 Gycm <superscript>2</superscript> (range, 0.8 186.5 Gycm <superscript>2</superscript> ), 1.9 Gycm <superscript>2</superscript> (range, 0.2-111.7 Gycm <superscript>2</superscript> ), and 24.3 Gycm <superscript>2</superscript> (range, 0.2-157.5 Gycm <superscript>2</superscript> ) for LE DVT thrombolysis, unilateral chronic iliofemoral venous stenting, and endovascular IVC reconstruction, respectively.<br />Conclusions: Patient radiation exposure for endovascular deep venous interventions for central venous outflow obstruction measured in DAP and FT seemed to be less than and at most similar to anatomically comparable arterial interventions in the literature. However, these patients were usually much younger than those with arterial diseases and may need secondary interventions involving further radiation exposure in their lifetime.<br /> (Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Female
Humans
Male
May-Thurner Syndrome diagnostic imaging
Medical Audit
Middle Aged
Patient Safety
Postthrombotic Syndrome diagnostic imaging
Retrospective Studies
Risk Assessment
Risk Factors
Stents
Venous Insufficiency diagnostic imaging
Venous Thrombosis diagnostic imaging
Young Adult
Endovascular Procedures adverse effects
Endovascular Procedures instrumentation
May-Thurner Syndrome therapy
Postthrombotic Syndrome therapy
Radiation Dosage
Radiation Exposure adverse effects
Radiography, Interventional adverse effects
Thrombolytic Therapy adverse effects
Vascular Surgical Procedures adverse effects
Venous Insufficiency therapy
Venous Thrombosis therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2213-3348
- Volume :
- 8
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery. Venous and lymphatic disorders
- Publication Type :
- Academic Journal
- Accession number :
- 31248834
- Full Text :
- https://doi.org/10.1016/j.jvsv.2019.03.018