TCT-232: Procedure Time, Fluoroscopy Time And Radiation Dose As Predictors Of Competence In Radial Versus Femoral Angiography

Abstract BACKGROUND The transradial access (TRA) is rapidly gaining popularity for neuroendovascular procedures as there is strong evidence for its benefits compared to the traditional transfemoral access (TFA). However, the transition to TRA bears some challenges including optimization of the interventional suite set-up and workflow as well as its impact on fellowship training. OBJECTIVE To compare the learning curves of TFA and TRA for diagnostic cerebral angiograms in neuroendovascular fellowship training. METHODS We prospectively collected diagnostic angiogram procedural data on the performance of 2 neuroendovascular fellows with no prior endovascular experience who trained at our institution from July 2018 until June 2019. Metrics for operator proficiency were minutes of fluoroscopy time, procedure time, and volume of contrast used. RESULTS A total of 293 diagnostic angiograms were included in the analysis. Of those, 57.7% were TRA and 42.3% were TFA. The median contrast dose was 60 cc, and the median radiation dose was 14 000 μGy. The overall complication rate was 1.4% consisting of 2 groin hematomas, 1 wrist hematoma, and 1 access-site infection using TFA. The crossover rate to TFA was 2.1%. Proficiency was achieved after 60 femoral and 95 radial cases based on fluoroscopy time, 52 femoral and 77 radial cases based on procedure time, and 53 femoral and 64 radial cases based on contrast volume. CONCLUSION Our study demonstrates that the use of TRA can be safely incorporated into neuroendovascular training without causing an increase in complications or significantly prolonging procedure time or contrast use.

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Distal Radial Artery Access for Superficial Femoral Artery Interventions

Journal of Endovascular Therapy ◽

10.1177/1526602820963022 ◽

2020 ◽

pp. 152660282096302

Author(s):

Zoltán Ruzsa ◽

Ádám Csavajda ◽

Balázs Nemes ◽

Mónika Deák ◽

Péter Sótonyi ◽

...

Keyword(s):

Radiation Dose ◽

Femoral Artery ◽

Superficial Femoral Artery ◽

Fluoroscopy Time ◽

Complication Rates ◽

Procedure Time ◽

Technical Success ◽

Access Site ◽

Femoral Access ◽

Crossover Rate

Purpose: To compare the acute success and complication rates of distal radial (DR) vs proximal radial (PR) artery access for superficial femoral artery (SFA) interventions. Materials and Methods: Between 2016 and 2019, 195 consecutive patients with symptomatic SFA stenosis were treated via DR (n=38) or PR (n=157) access using a sheathless guide. Secondary access was achieved through the pedal artery when necessary. The main outcomes were technical success, major adverse events (MAEs), and access site complications. Secondary outcomes were treatment success, fluoroscopy time, radiation dose, procedure time, and crossover rate to another puncture site. Results: Overall technical success was achieved in 188 patients (96.4%): 37 of 38 patients (97.3%) in the DR group and 151 of 157 patients (96.2%) in the PR group (p=0.9). Dual (transradial and transpedal) access was used in 14 patients (36.8%) in the DR group and 28 patients (18.9%) in the PR group (p<0.01). Chronic total occlusions were recanalized in 25 of 26 DR patients (96.1%) and in 79 of 81 PR patients (92.6%) (p=0.57). The crossover rate to femoral access was 0% in the DR group vs 3.2% in the PR group (p=0.59). Stents were implanted in the SFA in 15 DR patients (39.4%) and in 39 patients (24.8%) in the PR group (p=0.1). The contrast volume, fluoroscopy time, radiation dose, and procedure time were not statistically different between the DR and PR groups, nor were the rates of access site complications (2.6% and 7.0%, respectively). The cumulative incidences of MAE at 6 months in the DR and PR groups were 15.7% vs 14.6%, respectively (p=0.8). Conclusion: SFA interventions can be safely and effectively performed using PR or DR access with acceptable morbidity and a high technical success rate. DR access is associated with few access site complications.

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Image Fusion During Standard and Complex Endovascular Aortic Repair, to Fuse or Not to Fuse? A Meta-analysis and Additional Data From a Single-Center Retrospective Cohort

Journal of Endovascular Therapy ◽

10.1177/1526602820960444 ◽

2020 ◽

pp. 152660282096044

Author(s):

Sabrina A. N. Doelare ◽

Stefan P. M. Smorenburg ◽

Theodorus G. van Schaik ◽

Jan D. Blankensteijn ◽

Willem Wisselink ◽

...

Keyword(s):

Radiation Dose ◽

Image Fusion ◽

Data Extraction ◽

Meta Analysis ◽

Endovascular Aneurysm Repair ◽

Fusion Imaging ◽

Fluoroscopy Time ◽

Control Group ◽

Procedure Time ◽

Contrast Volume

Purpose: To determine if image fusion will reduce contrast volume, radiation dose, and fluoroscopy and procedure times in standard and complex (fenestrated/branched) endovascular aneurysm repair (EVAR). Materials and Methods: A search of the PubMed, Embase, and Cochrane databases was performed in December 2019 to identify articles describing results of standard and complex EVAR procedures using image fusion compared with a control group. Study selection, data extraction, and assessment of the methodological quality of the included publications were performed by 2 reviewers working independently. Primary outcomes of the pooled analysis were contrast volume, fluoroscopy time, radiation dose, and procedure time. Eleven articles were identified comprising 1547 patients. Data on 140 patients satisfying the study inclusion criteria were added from the authors’ center. Mean differences (MDs) are presented with the 95% confidence interval (CI). Results: For standard EVAR, contrast volume and procedure time showed a significant reduction with an MD of −29 mL (95% CI −40.5 to −18.5, p<0.001) and −11 minutes (95% CI −21.0 to −1.8, p<0.01), respectively. For complex EVAR, significant reductions in favor of image fusion were found for contrast volume (MD −79 mL, 95% CI −105.7 to −52.4, p<0.001), fluoroscopy time (MD −14 minutes, 95% CI −24.2 to −3.5, p<0.001), and procedure time (MD −52 minutes, 95% CI −75.7 to −27.9, p<0.001). Conclusion: The results of this meta-analysis confirm that image fusion significantly reduces contrast volume, fluoroscopy time, and procedure time in complex EVAR but only contrast volume and procedure time for standard EVAR. Though a reduction was suggested, the radiation dose was not significantly affected by the use of fusion imaging in either standard or complex EVAR.

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462 Comparing the Impact of Transradial and Transfemoral Coronary Angiography on the Radiation Dose, Contrast Volume and Fluoroscopy Time in Patients With Varying BMI

Heart Lung and Circulation ◽

10.1016/j.hlc.2020.09.469 ◽

2020 ◽

Vol 29 ◽

pp. S244

Author(s):

E. Tran ◽

S. Campbell ◽

K. Singh ◽

J. Forster ◽

R. Veraiahgari ◽

...

Keyword(s):

Radiation Dose ◽

Coronary Angiography ◽

Fluoroscopy Time ◽

Contrast Volume ◽

The Impact

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Use of the Magellan Robotic System for Conventional Transarterial Chemoembolization (cTACE): A 6-Patient Case Series Showing Safety and Technical Success

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0039-1694093 ◽

2019 ◽

Vol 03 (02) ◽

pp. 142-146 ◽

Cited By ~ 1

Author(s):

Warren Clements ◽

Madeleine Scicchitano ◽

Jim Koukounaras ◽

Tim Joseph ◽

Gerard S. Goh

Keyword(s):

Radiation Dose ◽

Adverse Events ◽

Transarterial Chemoembolization ◽

First Generation ◽

Case Series ◽

Fluoroscopy Time ◽

Technical Success ◽

Catheter Tip ◽

Further Development ◽

Generation Technology

AbstractRobotic endovascular technology is an emerging concept, and is being developed to allow more precise navigation of anatomy in challenging endovascular cases. The Magellan Endovascular System allows either direct or remote steerability of a 2-point articulating robotic platform with the ability to place a conventional microcatheter through the catheter tip. Such flexibility may help to reach an otherwise difficult anatomic location, especially in variant anatomy. To date, this platform has been shown to be technically successful in a small number of different settings. This case series shows another potential platform for such technology and explores the technical use and overall safety in conventional transarterial chemoembolization (cTACE). The study retrospectively assessed 6 patients undergoing selective cTACE. Treatments were performed in a single center by two experienced interventional radiologists. Fluoroscopy time, radiation dose, anatomic target, and adverse events were logged. In spite of a longer than expected average fluoroscopy time, which can be expected for a first-generation technology, the average radiation dose was comparable to literature and technical success was able to be shown in all 6 patients with no adverse events. This technology has wide scope for future use and once overcoming a learning curve, may allow us to avoid repeat procedure attempts thus reducing fluoroscopy time and leading to earlier successful treatment. Providing a platform of interest and usability in the interventional radiology world may also lead to further development of smaller, cheaper, and more widely-accessible devices.

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Endoscopic Sphincterotomy Combined With Large Balloon Dilation Can Reduce the Procedure Time and Fluoroscopy Time for Removal of Large Bile Duct Stones

Yearbook of Gastroenterology ◽

10.1016/s0739-5930(09)79321-3 ◽

2009 ◽

Vol 2009 ◽

pp. 37-38

Author(s):

S. Lange

Keyword(s):

Bile Duct ◽

Endoscopic Sphincterotomy ◽

Balloon Dilation ◽

Fluoroscopy Time ◽

Bile Duct Stones ◽

Procedure Time ◽

Large Balloon ◽

Large Balloon Dilation ◽

Large Bile Duct

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Pull-Type Radiologically Inserted Gastrostomy: An Improvised Technique Using a Frugal Innovation

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0039-1681124 ◽

2019 ◽

Vol 03 (01) ◽

pp. 007-011

Author(s):

Anurag Chahal ◽

Sundeep Malla ◽

Chinmaya Dash ◽

Deepak Gupta ◽

Shivanand Gamanagatti

Keyword(s):

Radiation Dose ◽

Safety Profile ◽

Conventional Technique ◽

New Technique ◽

Fluoroscopy Time ◽

P Value ◽

Complication Rates ◽

Nasogastric Feeding ◽

Group A ◽

Group B

Abstract Purpose To describe a new technique for “pull type” radiologically inserted gastrostomy (RIG) and prospectively compare it with conventional (described) technique in terms of technical ease (fluoroscopy time, radiation dose) and safety profile. Materials and Methods Adult patients with head injury with Glasgow coma scale (GCS) (M score) < 5, one week after decompression or those requiring nutritional support for > 4 weeks, or patients with recurrent aspiration pneumonitis on nasogastric feeding were included. Hemodynamically unstable patients or those with uncorrectable coagulopathy were excluded. Patients underwent pull-type RIG with alternate patient getting allocated to groups A (conventional technique) and B (new technique). The authors compared the technical success, complication rate, fluoroscopy time, radiation dose, and cost of hardware in these two groups. Results The average fluoroscopy time for group A (9 patients) was 498.7 ± 145.3 seconds, whereas for group B (16 patients), it was 302.8 ± 54.1 seconds with p-value = 0.06. The mean radiation dose of group A was 74.7 ± 15.7 mGy, whereas for group B, it was 56.7 ± 14.1 mGy (p-value = 0.004). The minor complication rates were 11.1% in both the groups. Conclusion The authors’ innovative technique using a customized snare has the potential to increase the technical ease of pull-type RIG with reduced fluoroscopy time, radiation dose, and cost with a similar safety profile.

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