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      Abdominal aorta aneurysm: Case report of high radiation dose during stent-graft implantation

      case-report

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          Summary

          This study is a case report regarding a possible problem of high radiation dose during stent-graft implantation. Before deciding on how to treat an aneurysm (stent grafting or traditional surgery), possible complications such as difficult anatomical conditions and diseases of the aorta and iliac arteries should be considered to avoid potentially high doses of radiation. In case of this patient, it was very difficult to introduce a guidewire through the contralateral limb into the body of the graft due to tortuosity and kinking of iliac arteries. Because of the long duration of the procedure (68 min), the patient was exposed to a very high radiation dose (4.37 Gy) and DAP (1760.3 Gy cm 2).

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          AneuRx stent graft versus open surgical repair of abdominal aortic aneurysms: multicenter prospective clinical trial.

          Christopher Zarins, Rodney White, Donald Schwarten … (1999)
          The results of a prospective, nonrandomized, multicenter clinical trial that compared endovascular stent graft exclusion of abdominal aortic aneurysms with open surgical repair are presented. During an 18-month period, 250 patients with infrarenal aneurysms underwent treatment at 12 study sites-190 patients underwent endovascular repair using the Medtronic AneuRx stent graft (Sunnyvale, Calif), and 60 underwent open surgical repair. There was no significant difference in operative mortality rates between the groups. The patients who underwent stent grafting had significant reductions in blood loss, time to extubation, and days in the intensive care unit and in the hospital, with an earlier return to function. The major morbidity rate was reduced from 23% in the surgery group to 12% (P <. 05) in the stent graft group. There was no difference in the combined morbidity/mortality rates between the two groups. Primary technical success at the time of discharge for the patients with stent grafts was 77%, largely as a result of a 21% endoleak rate. At 1 month, the endoleak rate had decreased to 9%. There was no difference in the primary or secondary procedure success rates at 30 days between the surgery and stent graft groups. The primary graft patency rate at 6 months was 98% in the surgery group and 97% in the stent graft group. The aneurysm exclusion rate at 1 month and 6 months was 100% in patients who underwent surgery and 91% in patients who underwent stent grafting. Stent graft migration occurred in three patients and resulted in late endoleaks; each endoleak was corrected by means of endovascular placement of a stent graft extender cuff. There have been no aneurysm ruptures and no surgical conversions to open repair in the stent graft group. Stent graft repair compares favorably with open surgical repair, with a reduced morbidity rate, shortened hospital stays, and satisfactory short term outcomes.
          Article 0 comments Cited 15 times – based on 0 reviews     Review now
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            Preliminary reference levels in interventional cardiology.

            Nicki Dowling, C J Kotre, Carlos Padovani … (2003)
            This article describes the European DIMOND approach to defining reference levels (RLs) for radiation doses delivered to patients during two types of invasive cardiology procedures, namely coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA). Representative centres of six European countries recorded patients' doses in terms of dose-area product (DAP), fluoroscopy time and number of radiographic exposures, using X-ray equipment that has been subject to constancy testing. In addition, a DAP trigger level for cardiac procedures which should alert the operator to possible skin injury, was set to 300 Gyxcm2. The estimation of maximum skin dose was recommended in the event that a DAP trigger level was likely to be exceeded. The proposed RLs for CA and PTCA were for DAP 45 Gyxcm2 and 75 Gyxcm2, for fluoroscopy time 7.5 min and 17 min and for number of frames 1250 and 1300, respectively. The proposed RLs should be considered as a first approach to help in the optimisation of these procedures. More studies are required to establish certain "tolerances" from the proposed levels taking into account the complexity of the procedure and the patient's size.
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              Entrance skin dose estimates derived from dose-area product measurements in interventional radiological procedures.

              B McParland (1998)
              Patient skin doses resulting from interventional radiological procedures have the potential to exceed threshold doses for deterministic effects such as erythema and epilation. If the irradiation geometry is known, the entrance skin dose can be estimated from the measured dose-area product. For each of 10 non-coronary interventional procedures, a nominal geometry was identified. From a previous survey of patient dose-area products, the entrance skin doses were estimated under the assumption that all procedures were performed with the nominal geometry specific to it. An analysis of the uncertainties in these doses caused by realistic deviations from the nominal geometry was also performed and it was shown that the estimated entrance skin dose values are at least to within 40%, and generally to within about 30%, of those actually received. For example, the median estimated entrance skin doses for the posteroanterior and lateral projections of cerebral angiography were 100 and 110 mGy. respectively, and for hepatic angiography 425 mGy. The largest entrance skin dose estimate for a single projection was for the angiography component of a CT arterial portography procedure at 670 mGy. Comparisons between entrance skin dose estimates obtained from this study are made with data from other interventional radiology patient dose surveys.
              Article 0 comments Cited 10 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pol J Radiol
                Journal ID (iso-abbrev): Pol J Radiol
                Journal ID (publisher-id): Pol J Radiol
                Title: Polish Journal of Radiology
                Publisher: International Scientific Literature, Inc.
                ISSN (Print): 1733-134X
                ISSN (Electronic): 1899-0967
                Publication date (Print): Oct-Dec 2011
                Volume: 76
                Issue: 4
                Pages: 60-62
                Affiliations
                [1 ] Department of Radiology, K. Marcinkowski, Poznań University of Medical Sciences, Poznań, Poland
                [2 ] Faculty of Physics, Department of Biomedical Physics, University of Warsaw, Warsaw, Poland
                [3 ] Department of General and Vascular Surgery, Poznań University of Medical Sciences, Poznań, Poland
                Author notes
                Author’s address: Natalia Majewska, Poznan University of Medical Sciences, Długa 1/2, 61-648 Poznań, Poland, e-mail: divines@ 123456tlen.pl
                Article
                Publisher ID: poljradiol-76-4-60
                PMC ID: 3389940
                PubMed ID: 22802857
                SO-VID: a9db2966-4d03-46f7-94ec-a5986a3931ec
                Copyright © © Pol J Radiol, 2011
                License:

                This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited.

                History
                Date received : 21 February 2011
                Date accepted : 16 August 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: high dose,radiation,x-ray,abdominal stentgraft
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: high dose, radiation, x-ray, abdominal stentgraft

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