Radiation exposure in patients treated with endovascular aneurysm repair: what is the risk of cancer, and can we justify treating younger patients?
Background Endovascular aneurysm repair (EVAR) is becoming the mainstay treatment of abdominal aortic aneurisms (AAA). The postoperative follow-up regime includes a lifelong series of CT angiograms (CTAs) at different intervals in addition to EVAR, which will confer significant cumulative radiation exposure over time. Purpose To examine the impact of age and follow-up regime over time on cumulative radiation exposure and attributable cancer risk after EVAR. Material and Methods We calculated a mean effective dose (ED) for the EVAR procedure, CTA, and plain abdominal X-rays (PAX). Cumulative ED was calculated for standard, complex, and simplified surveillance over 5, 10, and 15 years for different age groups. Results For EVAR, the mean ED was 34 mSv (range, 12-75 mSv) per procedure. For PAX, the ED was 1.1 mSv (range, 0.3-4.4 mSv), and for CTA it was 8.0 mSv (range, 2-20 mSv). For a 55-year-old man, an attributable cancer risk (ACR) in standard surveillance at 5 and 15 years of follow-up was 0.35% and 0.65%, respectively. The corresponding values were 0.22% and 0.37% for a 75-year-old man. When using a simplified follow-up, the ACRs for a 55-year-old at 5 and 15 years were 0.30% and 0.37%, respectively. These values were 0.18% and 0.21% for a 75-year-old man. A complex follow-up with half-yearly CTA over similar age and time span doubled the ACR. Conclusion Treating younger patients with EVAR poses a low ACR of 0.65% (15-year standard surveillance) compared to a lifetime cancer risk of 44%. A simplified surveillance should be used if treating younger patients, which will halve the ACR over 15 years.
1 Vascular Department, Oslo University Hospital, Oslo, Norway.|2 Medical faculty, University of Oslo, Oslo, Norway.
Thomas
T
Nyheim
1 Vascular Department, Oslo University Hospital, Oslo, Norway.
Lars E
LE
Staxrud
1 Vascular Department, Oslo University Hospital, Oslo, Norway.|2 Medical faculty, University of Oslo, Oslo, Norway.
Jørgen J
JJ
Jørgensen
3 Department of Physics, University of Oslo, Oslo, Norway.
Kristin
K
Jensen
4 Buskerud and Vestfold University College, Faculty of Health Sciences, Kongsberg, Norway.|5 Norwegian Radiation Protection Authority, Østerås, Norway.
Hilde M
HM
Olerud
2 Medical faculty, University of Oslo, Oslo, Norway.|6 Centre for Thoracic, Vascular and Interventional Radiology, Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
Gunnar
G
Sandbæk
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000706:statistics & numerical data*; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology*; D000069079:Radiation Exposure / Q000706:statistics & numerical data*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D016896:Treatment Outcome
Vascular; aneurysms; computed tomography (CT) angiography; radiation effects; stents and biological effects