Impact of patient anatomy on radiation dose during endovascular repair of abdominal aortic aneurysms

Introduction: Endovascular aortic aneurysm repair (EVAR) has increasingly become the mainstream treatment of abdominal aortic aneurysms. However, since it requires the use of ionizing radiation, concerns on both patient and surgeon exposure have been raised. Methods: A retrospective analysis was conducted to evaluate all patients who underwent standard infra-renal endovascular aneurysm repair (EVAR) using aorto-bi-iliac endoprosthesis for infrarenal abdominal aortic aneurysms (AAAs) from January 2018 to December 2022. All procedures were performed using the Ziehm Vision RFD mobile C-arm system (Ziehm Imaging, Nuremberg, Germany). Primary endpoint was to determine whether BMI was an independent predictor of intraoperative radiation exposure during EVAR procedures. Results: A total of 91 patients with information of DAP were included, and of these 76 had information on height and weight for BMI calculation, with 72 males (94.7%) and mean age 73.5±8.3 years. Mean BMI was 27.2±4.0 kg/m2, with 41% of patients being overweight and 22% obese. Median DAP was 77.9 Gy.cm2 (inter-quartile range [IQR] 51-123). DAP did not differ between sex. A higher BMI category was associated with higher DAP values (p=0.008). Higher DAP was also associated with general anesthesia (p=0.002) and intra-operative complications (p=0.031). On multiple linear regression, BMI remained an independent variable for higher DAP, with each increase in kg.m2 of BMI increasing DAP by 5.15 Gy.cm2 (p=0.010). Conclusions: Higher BMI is associated with increased dose of radiation in standard EVAR procedures, which may be relevant when reducing both patients’ and professionals’ radiation exposure.