title: Techniques to reduce radiation and contrast volume during EVAR.
abstract: There is a large variability observed in the literature regarding radiation exposure and contrast volume injection during endovascular aortic repair (EVAR). Reducing both in order to decrease their respective toxicities must be a priority for the endovascular therapist. Radiation dose reduction requires a strict application of the "as low as reasonably achievable" principles. Firstly, all X-ray system settings should be defaulted to low dose, and fluoroscopic time reduced as much as possible. Digital subtraction angiography runs should be replaced by recorded fluoroscopy runs when possible. Magnification should be avoided, whereas collimation should be systematic to minimize scatter radiation and focus only on the area of interest. Advanced imaging modes can also contribute to dose reduction. For instance, image fusion can facilitate endovascular navigation, and allow table and C-arm positioning without fluoroscopy. In our experience, routine use of image fusion during EVAR significantly reduces both radiation exposure and contrast volumes during complex EVAR. To make these imaging modes useable in real life settings, the X-ray system should be fully controlled by the operator from table side. Reducing iodinated contrast volume, while maintaining image quality, can also be achieved through the use of automated contrast injectors. Additionally, alternative contrast agents, like carbon dioxide (CO2) and gadolinium, have also been evaluated and can be used in specific cases. Contrast-enhanced ultrasound and intravascular ultrasonography are currently developed as potential alternatives to both iodinated contrast use and X-ray during EVAR. Lastly, specific education and training of operators in radiation protection are essential.
authors.affiliation: Departments of Vascular Surgery Hôpital Cardiologique, CHRU Lille, France - stephan.haulon@chru-lille.fr.
authors.forename: B
authors.initials: B
authors.lastname: Maurel
authors.forename: A
authors.initials: A
authors.lastname: Hertault
authors.forename: J
authors.initials: J
authors.lastname: Sobocinski
authors.forename: M
authors.initials: M
authors.lastname: Le Roux
authors.forename: T Martin
authors.initials: TM
authors.lastname: Gonzalez
authors.forename: R
authors.initials: R
authors.lastname: Azzaoui
authors.forename: M
authors.initials: M
authors.lastname: Saeed Kilani
authors.forename: M
authors.initials: M
authors.lastname: Midulla
authors.forename: S
authors.initials: S
authors.lastname: Haulon
mesh_terms: D015901:Angiography, Digital Subtraction; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000009:adverse effects / Q000379:methods; D003287:Contrast Media / Q000009:adverse effects; D004501:Education, Medical; D057510:Endovascular Procedures / Q000009:adverse effects / Q000193:education; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control; D060051:Occupational Injuries / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control; D011835:Radiation Protection; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000009:adverse effects; D015642:Radiology, Interventional / Q000193:education; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D003287:Contrast Media