A Multicenter Survey of Endovascular Theatre Equipment and Radiation Exposure in France during Iliac Procedures

Background The aim of this study is to evaluate radiation exposure, endovascular theatre equipment, and practices in France during iliac angioplasty. Methods A prospective observational study was performed among vascular surgeons who attended a half day of radiation safety training in 2012 and 2015 and had to collect data on 3 patients undergoing iliac procedure. In 2012, 330 surgeons performed 899 procedures, compared with 114 surgeons and 338 procedures in 2015. Due to exclusions, 653 and 306 procedures were analyzed in 2012 and 2015, respectively. Endovascular environment, practices, anatomical characteristics, and radiation parameters were collected, analyzed, and compared generally and between the 2 groups. Results Endovascular theatre equipment significantly improved over the 3 years: mobile flat-panel detector (1.1% vs. 5.9%), hybrid rooms (1.5% vs. 14.7%), and dedicated radiology tables (37.2% vs. 51.2%). Lesion’s classification (Trans-Atlantic Society Consensus) was similar between groups but procedure complexity increased overtime: more than one stent implanted (32.3% vs. 41%, P < 0.01), cross over (11.5% vs. 16%, P < 0.05), and kissing procedures (19.3% vs. 24.2%, P = 0.05). The mean dose area product (DAP) was 14.2 ± 18.9 Gy cm2 in 2012 and 21.5 ± 37.6 Gy cm2 in 2015 (P < 0.01), and the mean fluoroscopy time was 4.8 ± 5.5 min and 5.2 ± 5.9 min, respectively (nonsignificant). Overall, hybrid rooms, body mass index over 25 kg/m2, more than one stent implanted, and crossover technique were associated with a significantly higher DAP. Conclusions Over 3 years, a large population of vascular surgeons improved radiation safety knowledge, operative environment, and technical complexity. However, these changes have led to an increased DAP in 2015, which underline the outmost importance of low dose settings and application of ALARA (as low as reasonably achievable) principles in every day practice.