Original title: Patient radiation exposure during percutaneous endovascular revascularization of the lower extremity. Reference: Einat Segal et al. Journal of Vascular Surgery. Article in press.

Percutaneous endovascular revascularization is emerging as the first line treatment for peripheral artery disease for both intermittent claudication and chronic critical limb ischemia. Radiation doses for these interventions, usually prolonged, have not been well documented.

This retrospective study evaluated all lower extremity angioplasty procedures between 2006 and 2011 in a single center. Fluoroscopy time and dose area product (DAP) were registered. 382 procedures in 313 patients receiving lower extremity revascularization were included; a significantly higher DAP was observed in the primitive or the external iliac arteries compared to those performed in femoropopliteal (179.6 vs 63.2 Gy/cm2; p

The contraleteral access resulted in a in a higher DAP than the antegrade access (112.2 vs 42.6 Gy/cm2; p < 0.0001). In a multivariable analysis, the anatomical location of lesions presented the strongest association with radiation dose (p

Conclusion:

Revascularization procedures on lower extremities involve substantial radiation doses that can be compared, on average, with abdomen and pelvis CT scans. Pelvis procedures involve higher doses than those performed in femoropopliteal or infrapatellar territories.

 Editorial Comment:

Radiation doses should be taken into account especially in recanalization procedures of iliac arteries. For femoral or intrapatellar procedures, the antegrade access should be preferred whenever possible. Both the technical difficulty of puncture and the greater chance of complications should be counterbalanced with greater support, a stronger drive and now also lower radiation doses.

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