March 06, 2019
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Potentially harmful radiation doses occur in 1 of 14 PAD procedures

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Charles E. Chambers
Charles E. Chambers

One in 14 patients who undergoes endovascular intervention for lower-extremity peripheral artery disease receives a radiation dose large enough to cause tissue injury, researchers reported.

“We determined that 7% of lower-extremity endovascular interventions expose patients to > 500 Gy x cm2, a threshold above which follow-up is indicated” by the National Council on Radiation Protection and Measurements, Andrew M. Goldsweig, MD, from the division of cardiovascular medicine, University of Nebraska Medical Center, and colleagues wrote.

Goldsweig and colleagues obtained data on radiation dosage, defined as dose-area product, from 17,174 lower-extremity endovascular procedures at 73 sites documented in the National Cardiovascular Data Registry Peripheral Vascular Intervention Registry.

The researchers determined the proportion of procedures exceeding 500 Gy x cm2 and identified patient and procedural factors associated with elevated dose-area product.

Patient dose-area product was more than 500 Gy x cm2 in 7% of procedures, according to the researchers.

The predictor of elevated dose-area product with the greatest magnitude of effect was more proximal lesion location, Goldsweig and colleagues wrote. Other significant predictors, in order of magnitude of effect, were bifurcation lesion, male sex, diabetes, hypertension, prior PCI, elevated lesion length and elevated BMI.

Predictors of decreased dose-area product included antegrade vascular access, critical limb ischemia and increasing age, the researchers wrote.

“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,” the researchers wrote. “Preprocedural assessment of patients’ risk for elevated radiation dosage may allow targeted use of radiation mitigation strategies in patients at increased risk for elevated exposure.”

In a related editorial, Charles E. Chambers, MD, from Hershey Medical Center in Pennsylvania, wrote that limitations include that cumulative air kerma, a better predictor of skin injury than dose-area product, was not reported, and that “the lack of data entry oversight and case exclusion for incomplete data create potential bias.”

“As peripheral intervention expands both in potential procedures and in potential operators, quality oversight must similarly expand to assess best practices to ensure optimal patient care,” Chambers wrote. – by Erik Swain

Disclosures: The authors and Chambers report no relevant financial disclosures.