Giet, L;
Evans, N;
Papadopoulou, A;
Khalifa, M;
Tsui, J;
Hamilton, G;
Brookes, J;
(2021)
Patient radiation exposure from embolo-sclerotherapy of peripheral vascular malformations.
Journal of Vascular Surgery
, 73
(5)
pp. 1794-1799.
10.1016/j.jvs.2020.08.152.
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Abstract
Objective: Embolo-sclerotherapy (EST) is the mainstay therapy for peripheral vascular malformations which involves the exposure of patients to ionizing radiation. We aimed to analyze the radiation exposure to patients from EST of peripheral vascular malformations over five years in a single specialist center. / Methods: All patients who had EST performed in a single specialist center for peripheral vascular malformations between January 1st 2013 and January 8th 2018 were identified from a prospectively collected database. Data collection included basic demographics, procedure date, anatomical site, type of vascular malformations and procedural details. Radiation exposure, measured in dose-area product (DAP) and fluoroscopy times, of all patients identified to have EST during the period were retrospectively reviewed. Statistical analysis was performed using Mann-Whitney U and Kruskal-Wallis tests for comparison between subgroups. P<0.05 was considered significant. / Results: A total of 237 patients (median age 30 years; range 1 – 73 years) underwent 419 ESTs during the study period. Of these, 61 (25.7%) patients had arteriovenous malformations (AVM) and underwent 140 (33.4%) ESTs. Meanwhile, 176 (74.3%) patients had venous and lymphatic malformations and underwent 279 ESTs (66.6%). Patients with AVMs had a median of 2 procedures (range 1 - 13), compared to a median of 1 (range 1 - 6) for venous and lymphatic malformations within the study period. The median DAP for single and cumulative EST for peripheral vascular malformations were 1.26 Gycm2 (range 0.00 – 698.36 Gycm2) and 1.91 Gycm2 (range 0.00 – 1300.24 Gycm2), respectively. Whereas, the median fluoroscopy time for single and cumulative EST were 19 seconds (range 1 – 3846 seconds) and 30 seconds (range 1 – 5843 seconds), respectively. Significantly higher patient radiation exposure, in DAP and fluoroscopy times, were measured for single and cumulative EST for AVM when compared with venous and lymphatic malformation (both p <0.01; Mann Whitney U). A significant difference in DAP but not fluoroscopy time was found when anatomical areas of vascular malformations were compared. / Conclusions: Patient radiation exposure for EST of peripheral vascular malformations, measured in DAP and fluoroscopy times, appeared to be generally less than those reported for endovascular arterial and deep venous interventions in the literature. However, some patients with peripheral vascular malformations received relatively high radiation doses. Further studies to investigate the risk factors and long-term side-effects of radiation exposure in these patients and strategies to reduce it are required.
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