Analysis of radiation exposure in endovascular treatment of chronic limb-threatening ischemia by arterial access and Global Limb Anatomic Staging System classification.

Abstract

Endovascular therapy for the treatment of chronic limb-threatening ischemia (CLTI) continues to evolve with the development of new techniques and devices. However, data on radiation dose during CLTI revascularization using two different types of C-arms remains limited. The objective of this study was to analyze radiation dose parameters during revascularization of CLTI, considering arterial access and Global Limb Anatomic Staging System (GLASS) classification, using two different types of C-arms. A cross-sectional, non-randomized study of endovascular procedures was performed for the revascularization of CLTI. All procedures were performed percutaneously in two different C-arm devices: mobile (MCA) and hybrid room (HR). Procedures were stratified according to GLASS classification. The arterial accesses included antegrade femoral, contralateral femoral, brachial, and double arterial access (defined as the combination with the retrograde access). Dosimetric parameters, including air-Kerma area product (KAP), fluoroscopy time (FT), cumulative air Kerma (CAK), and contrast volume, were collected. During the period from July 2020 to September 2023, 465 procedures were performed on 373 patients. Mean patient age was 73.4 years (standard deviation, 11.24 years; range, 37-99 years). The median CAK for antegrade access was significantly higher in HR compared with MCA (6.08 Gy vs 3.33 Gy; P < .001). However, the median FT was lower in HR compared with MCA (795.13 seconds vs 981 seconds; P = .039). The mean KAP was significantly higher for contralateral access (19.22 Gy‧cm² vs 13.29 Gy‧cm²; P = .028) and double arterial access (17.4 Gy‧cm² vs 7.35 Gy‧cm²; P = .012) in HR compared with MCA. For all three GLASS categories, the mean KAP was significantly higher in HR compared with MCA (P < .05). Antegrade access showed lower KAP compared with the rest of the arterial accesses. Infrainguinal revascularizations performed in HR involve higher levels of KAP, with significant differences in all types of arterial access.