title: Clinical usefulness and safety of routine intraoperative angiography for patients and personnel.
abstract: OBJECTIVE
  The routine use of intraoperative angiography (IA) is still surrounded by controversy. We prospectively performed IAs in consecutive patients undergoing surgery for aneurysms, arteriovenous malformations, and dural arteriovenous fistulae. We calculated the percentage of identified residual pathologies, the cases requiring further surgical intervention, and the complication rates associated with the procedure. We also recorded radiation dose received by personnel during IA for comparison with elective procedures. If our review supported the routine use of IA, recommendations should be tempered by radiation dose to personnel regarding whether or not annual exposure would go beyond recommended limits and whether or not radiation doses indicate a need for specialized operating rooms.
  
  
  METHODS
  Two hundred and four consecutive IAs were performed on 191 patients over a 2-year period. Angiographic findings were reviewed retrospectively and noted for additional interventions. Complications related to IA were recorded. Radiation doses received by personnel and fluoroscopy times were compiled from 18 IAs. Mean dose/minutes in intraoperative procedures was compared with mean dose/minutes of a separate cohort of 15 elective angiograms (Student's t test).
  
  
  RESULTS
  Twenty-three percent of IAs revealed relevant findings. Clip repositioning or additional clip placement was performed in 8% of the patients. Resection of residual arteriovenous malformations or additional surgery for residual arteriovenous shunting in dural arteriovenous fistulae was performed in 2% of the patients. Fewer than 1% of the patients received intra-arterial verapamil or topical papaverine. The complication rate was less than 1%. The mean dose per procedure for physicians was 1.018 microsieverts (uSv) versus 0.988 uSv for technicians (P = 0.94). The mean effective dose/minutes in the angiogram suite was 0.9209 uSv/minute versus 1.213 uSv/minute in the operating room (P = 0.33).
  
  
  CONCLUSIONS
  IA identifies a significant number of pertinent findings during open neurovascular surgery, half of which require additional intervention. It is associated with a low complication rate. Radiation dose received by personnel per procedure is negligible. IA radiation dose is not different from dose in the angiogram suite; thus, specialized operating rooms may not be necessary. These data support routine intraoperative angiography in open surgeries for neurovascular disorders.
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, New York, New York 10032, USA. kl2215@columbia.edu
authors.forename: Kim A
authors.initials: KA
authors.lastname: Lopez
authors.forename: Allen E
authors.initials: AE
authors.lastname: Waziri
authors.forename: Robert
authors.initials: R
authors.lastname: Granville
authors.forename: Grace H
authors.initials: GH
authors.lastname: Kim
authors.forename: Philip M
authors.initials: PM
authors.lastname: Meyers
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.forename: Robert A
authors.initials: RA
authors.lastname: Solomon
authors.forename: Sean D
authors.initials: SD
authors.lastname: Lavine
mesh_terms: D002533:Cerebral Angiography / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D006282:Health Personnel; D006801:Humans; D016343:Monitoring, Intraoperative / Q000009:adverse effects* / Q000379:methods; D005791:Patient Care / Q000009:adverse effects* / Q000379:methods; D011829:Radiation Dosage