One in 14 patients undergoing peripheral endovascular intervention (PVI) using fluoroscopic imaging for the treatment of lower extremity peripheral artery disease suffer tissue injury from the treatment and have an increased risk of malignancy. Preprocedure assessments could enable the use of targeted treatments to reduce patient risk, according to a study published in JACC: Cardiovascular Interventions.

Andrew M. Goldsweig, MD, FACC, et al., collected data on 27,119 patients enrolled in ACC's PVI Registry from 2014 through 2017. Of those patients, 9,945 were excluded from this study because of missing data or if the procedure was aborted or performed for acute limb ischemia. Of the 17,174 procedures performed at 73 sites analyzed, in 7 percent the patient dose-area product (DAP) exceeded 500 Gy cm2, the threshold for radiation-related adverse effects set by the National Council on Radiation Protection and Measurements.

When undergoing fluoroscopy-guided PVI procedures, patients are exposed to ionizing radiation. Long procedures and the need for repeat procedures can expose patients to significant radiation dosages, increasing their risk for tissue injury and malignancy. Researchers developed a 32-variable hierarchical multivariate linear regression model to identify independent predictors of increased DAP. Because many of the 32 variables did not explain variability in DAP, a model based on seven of those variables was used, as they accounted for 90 percent of the variability. The seven predictors used in the reduced model, on order from greatest magnitude of effect are lesion location, procedure duration, body mass index, male sex, bifurcation lesion, diabetes and hypertension.

"Preprocedural assessment of procedural radiation risks allows the adoption of radiation reduction strategies specifically targeting patients at increased risk for high radiation dosage," the researchers conclude. "Further research regarding such strategies is necessary to reduce patients' risks for tissue injury and malignancy from procedural radiation exposure."

Keywords: PVI Registry, National Cardiovascular Data Registries, Angiography

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