Lens Radiation Exposure During Total Aortic Arch Repair With Double-Fenestrated Physician-Modified Stent Graft: A Prospective Study

Abstract

Objective:

The aim of this report is to quantify the radiation exposure of each person present in the operating room, with a focus on lens exposure, during total aortic arch repair using double-fenestrated PMEG (physician-modified endograft).

Methods:

Prospective, nonrandomized single-center study design. Radiation data from 22 procedures of aortic arch repair with double-fenestrated PMEG from February to June 2025 were analyzed. Patient dose information was collected by the imaging equipment. Real-time dosimetry was used to collect exposure data to the lens for the operators, first assistant, and anesthesiologist. The endpoints are overall equivalent doses and lens exposure.

Results:

A total of 11 patients were treated for arch aneurysm and 11 for chronic dissection. Mean body mass index (BMI) of the patient is 26.4 kg/m² (SD=3.5). Mean radiation time is 10 minutes (SD=4.4), median total radiation is 180 dGy.cm² (IQR=150), and air Kerma is 49 mGy (SD=81). Received lens doses are respectively for the main operator, the first assistant, and the anesthetist of 6.4 μSv (IQR=6.6), 0.62 μSv (IQR=0.67), and 2 μSv (IQR=2.02). Dose of iodine contrast injected was 40 mL in all patients. Radiation exposure was significantly higher when BMI was over 27 kg/m².

Conclusion:

Radiation protection is a critical concern for vascular surgeons as complex endovascular procedures routinely deliver measurable radiation to the eyes. Double-fenestrated PMEG is an endovascular solution for total aortic arch repair with acceptably low radiation exposure, particularly to the lens.

Clinical Impact

This study presents the results on 22 patients treated with double-fenestrated PMEG, with prospectively collected data on radiation exposure (overall and to the lens). It suggests that total aortic arch repair is feasible with acceptably low radiation exposure to both the patient and the operating room staff (main operator, first assistant, and anesthetist), especially regarding the lens exposure.

Keywords

PMEG radiation exposure lens exposure aortic arch repair thoracic aorta

Get full access to this article

View all access options for this article.

References

Bacri

Hireche

Alric

, et al. Total aortic arch repair with double-fenestrated physician-modified endografts, at least 3-year follow-up. J Vasc Surg. 2024;80(2):344–354.

Vento

Soler

Fabre

, et al. Optimizing imaging and reducing radiation exposure during complex aortic endovascular procedures. J Cardiovasc Surg (Torino). 2019;60(1):41–53.

Modarai

Haulon

Ainsbury

, et al. Editor’s choice: European Society for Vascular Surgery (ESVS) 2023 clinical practice guidelines on radiation safety. Eur J Vasc Endovasc Surg. 2023;65(2):171–222.

Derwich

Barb

Vogl

, et al. Influence of patient anatomy on intraoperative radiation exposure and operation time during standard EVAR. J Clin Med. 2023;12(18):5851.

Tsilimparis

Detter

Law

, et al. Single-center experience with an inner branched arch endograft. J Vasc Surg. 2019;69(4):977–985.

Tsilimparis

Law

Rohlffs

, et al. Fenestrated endovascular repair for diseases involving the aortic arch. J Vasc Surg. 2020;71(5):1464–1471.

Tenorio

Oderich

Kölbel

, et al. Multicenter global early feasibility study to evaluate total endovascular arch repair using three-vessel inner branch stent-grafts for aneurysms and dissections. J Vasc Surg. 2021;74(4):1055–1065.

Mohapatra

Greenberg

Mastracci

, et al. Radiation exposure to operating room personnel and patients during endovascular procedures. J Vasc Surg. 2013;58(3):702–709.

Attigah

Oikonomou

Hinz

, et al. Radiation exposure to eye lens and operator hands during endovascular procedures in hybrid operating rooms. J Vasc Surg. 2016;63(1):198–203.

10.

Federal Office for Radiation Protection. Limit values. Accessed, 2022. https://www.bfs.de/EN/topics/ion/radiation-protection/occupation/limitvalues/limit-values_node.html.

11.

Hamada

Azizova

Little

MP.

An update on effects of ionizing radiation exposure on the eye. Br J Radiol. 2020;93(1115):20190829.

12.

Jungi

Ante

Geisbüsch

, et al. Protected and unprotected radiation exposure to the eye lens during endovascular procedures in hybrid operating rooms. Eur J Vasc Endovasc Surg. 2022;64(5):567–572.