Author + information
- Tom Davis1
Interventional physicians have the highest rates of radiation exposure within the medical profession, due in large part to fluoroscopy – a gold standard for visualization in endovascular procedures. The cumulative effects of fluoroscopy exposure are only now becoming evident, with recent data correlating increased radiation exposure with increases in the risk of cancer. Recently, an optical coherence tomography (OCT) guided revascularization device (Pantheris, Avinger Inc.) was approved by the FDA for the treatment of PAD. OCT guided atherectomy revascularization allows for debulking of disease using OCT to guide the operator and effectively reduce the need for angiographic fluoroscopy. The goal of this study was to compare radiation use in procedures using OCT-guidance vs those under fluoroscopic guidance.
Retrospective radiation exposure measurements were collected from 102 patients undergoing revascularization in SFA and popliteal lesions. Matched patient cohorts were compared between OCT-guided atherectomy (n=52) and fluoroscopic guided atherectomy (n=50) at 11 centers around the United States. Procedural measurements collected included fluoroscopic toxicity (mGy), total contrast volume (mL), and total fluoroscopy time (min).
Results demonstrated a 63% reduction in median fluoroscopic exposure across all procedures (p<0.05). Effective dose measurements in Pantheris treated lesions was 463.10mSv, contrast 140.43mL, and total fluoroscopy time 23.7± 9.3min.
OCT guided atherectomy enabled physicians to significantly reduce both patient and operator fluoroscopy exposure as compared to other non-imaging devices. Changes in practice could lead to reduced fluoroscopic radiation exposure during endovascular procedures.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention