A COMPARISON OF RADIATION EXPOSURE DURING ENDOVASCULAR AORTIC ANEURYSM REPAIR WITH OR WITHOUT ENDOSTAPLING.

BACKGROUND: Complications of endovascular aneurysm repair (EVAR) include endoleaks, proximal neck dilatation and stent migration, which have a greater likelihood with larger neck angulations. To mitigate against these complications endostapling of the stent-graft to the aortic wall is being implemented. With this extra stage in EVARs, this study aims to establish whether use of endostapling increases patient radiation exposure.

METHOD: A retrospective analysis of a prospectively collected database of patients undergoing infrarenal EVAR and EVAR with endostapling was obtained. Radiation dose, fluoroscopy time, aneurysm size and patient characteristics were collected. Endostapling was performed using the Aptus Endostapling system (Aptus Endosystems Inc, Sunnyvale, Calif). Results are expressed as mean with 95% confidence interval. Statistical significance was set at P < 0.05 and calculated with an unpaired t-test.

RESULTS: This study included 30 patients undergoing elective aorto biiliac EVAR with endostapling and 147 patients undergoing elective aorto bi-iliac EVAR without endostapling. Patient characteristics between the two groups were comparable. Within the endostapled group the mean dose area product (DAP) was 5.54 (4.18-6.91) mGy.m2, cumulative air kerma (CAK) 289 (230-348) mGy and fluoroscopy time 35.9 (29.6-42.2) minutes. Within the non-endostapled group the mean DAP was 5.91 (5.07-6.75) mGy.m2, CAK 248 (211-284) mGy and fluoroscopy time 32.5 (28.5-36.5) minutes. There was no statistically significant difference in DAP, CAK or fluoroscopy time between patients undergoing EVAR with or without endostapling.

CONCLUSION: Radiation exposure during endovascular aneurysm repairs is a significant hazard to both the patient and the theatre staff. Our study shows that the additional step of endostapling the aortic stent-graft to prevent future reinterventions for endoleaks, stent migration or rupture does not increase radiation exposure to the patient.