Author + information
- Received September 18, 2018
- Revision received October 22, 2018
- Accepted November 6, 2018
- Published online March 4, 2019.
- Andrew M. Goldsweig, MDa,
- Kevin F. Kennedy, MSb,
- J. Dawn Abbott, MDc,
- W. Schuyler Jones, MDd,
- Poonam Velagapudi, MD, MSa,
- Frank J. Rutar, MSe,
- Jeptha C. Curtis, MDf,
- Thomas T. Tsai, MD, MScg and
- Herbert D. Aronow, MD, MPHc,∗ ()
- aDivision of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
- bDepartment of Cardiovascular Research, St. Luke’s Mid America Heart Institute, Kansas City, Missouri
- cDivision of Cardiovascular Medicine, Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island
- dDuke Clinical Research Institute and Division of Cardiovascular Medicine, Duke University, Durham, North Carolina
- eDepartment of Radiation Safety, University of Nebraska Medical Center, Omaha, Nebraska
- fYale New Haven Hospital Center for Outcomes Research and Evaluation and Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut
- gDivision of Cardiovascular Medicine, University of Colorado and Kaiser Permanente Colorado, Denver, Colorado
- ↵∗Address for correspondence:
Dr. Herbert D. Aronow, Division of Cardiovascular Medicine, Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, 593 Eddy Street, APC 730, Providence, Rhode Island 02903.
Objectives The aims of this study were to determine the incidence of actionably high radiation dosages and to identify predictors of increased patient dosage.
Background Peripheral endovascular intervention using fluoroscopic imaging has become a mainstay of treatment for lower extremity peripheral artery disease but exposes patients to ionizing radiation.
Methods Patient radiation dosage, quantified as dose-area product (DAP), was obtained from the National Cardiovascular Data Registry Peripheral Vascular Intervention Registry. The percentage of procedures exceeding a DAP of 500 Gy · cm2, the threshold above which follow-up for radiation-related adverse effects is indicated by the National Council on Radiation Protection and Measurements, was determined. A multivariate regression model was generated to identify patient and procedural factors associated with increasing DAP.
Results Among 17,174 procedures performed at 73 sites, patient DAP exceeded 500 Gy · cm2 in 7%. Independent predictors of increased patient DAP in order from greatest magnitude of effect included more proximal lesion location, bifurcation lesion, male sex, diabetes, hypertension, prior percutaneous coronary intervention, increasing lesion length, and increasing body mass index; antegrade vascular access, critical limb ischemia, and increasing age predicted decreased DAP.
Conclusions Radiation dosage with the potential for tissue injury occurs in 1 of every 14 patients undergoing lower extremity endovascular interventions, and all such patients are exposed to the potential for subsequent malignancy. Pre-procedural assessment of patients’ risk for elevated radiation dosage may allow targeted use of radiation mitigation strategies in patients at increased risk for elevated exposure.
Biostatistical support for this work was funded and provided by the National Cardiovascular Data Registry. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 18, 2018.
- Revision received October 22, 2018.
- Accepted November 6, 2018.
- 2019 American College of Cardiology Foundation
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