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• W4238791722 abstract "Introduction - The worldwide prevalence of peripheral artery disease (PAD) has evolved to an intervention as the primary treatment option and therefore radiation is used with escalating incidence. Dose area product (DAP) correlates well with the total energy imparted to the patient during fluoroscopic interventions. This study aims to determine whether there are any associations among stage of disease, gender, age, and expertise on the radiation dose in single endovascular treatments of PAD. Methods - This study was a prospective, mandatory, population based cross-sectional registry design. In total, 24,000 invasive percutaneous endovascular treatments of PAD conducted in the metropolitan area of Hamburg (Germany) were consecutively collected between January 2004 and December 2015. DAP was analysed by discipline conducting the procedure, Fontaine classification, patient gender, and age. Results - Statistically significant differences in median DAP values were found. The lowest median DAP values were observed in surgical centres (7.1 vs. 18.0 Gy*cm2, p<.001) and in endovascular revascularisations (ER) following multidisciplinary consultation (11.6 vs. 23.4 Gy*cm2, p<.001). Considering the treatment of intermittent claudication, men had statistically significantly higher DAP values compared with women. Furthermore, lower median DAP values were observed in higher age groups, with lowest dosages in octogenarians. Conclusion - This is the first large population based study on DAP during ER for PAD. Several significant differences in median DAP values were observed, although patient stratification was comparable. Pre-operative therapy strategy planning can lead to lower DAP values, emphasising the importance of further vascular research and quality improvement projects targeting this topic. To date, available evidence is limited and therefore there is no accepted range of DAP levels. However, the ever increasing use of fluoroscopic interventions means that further investigation into radiation exposure to patients and healthcare professionals is required in order to keep DAP levels low. References1.Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329-40.2.Malyar N, Fürstenberg T, Wellmann J, Meyborg M, Lüders F, Gebauer K, et al. Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis. European heart journal. 2013;34(34):2706-14.3.DeStatis SB. Krankenhausdiagnosestatistik URL: https://www.gbe-bund.de/: Statistisches Bundesamt DeStatis; 2014 [Gesundheitsberichterstattung des Bundes].4.Wagner LK, Eifel PJ, Geise RA. Potential biological effects following high X-ray dose interventional procedures. Journal of vascular and interventional radiology : JVIR. 1994;5(1):71-84.5.The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007;37(2-4):1-332.6.Carlsson C. Determination of Integral Absorbed Dose from Exposure Measurements. Acta Radiol Ther Phys Biol. 1963;1:433-58.7.Carlsson GA, Carlsson CA. Quantities and concepts used in radiation dosimetry. The International Journal of Applied Radiation and Isotopes. 1982;33(11):953-65.8.Wise KN, Sandborg M, Persliden J, Carlsson GA. Sensitivity of coefficients for converting entrance surface dose and kerma-area product to effective dose and energy imparted to the patient. Physics in medicine and biology. 1999;44(8):1937-54.9.Spira D, Kirchner S, Blumenstock G, Herz K, Ketelsen D, Wiskirchen J, et al. Therapeutic angiographic procedures: differences in dose area product between analog image intensifier and digital flat panel detector. Acta radiologica. 2016;57(5):587-94.10.Kocinaj D, Cioppa A, Ambrosini G, Tesorio T, Salemme L, Sorropago G, et al. Radiation dose exposure during cardiac and peripheral arteries catheterisation. International journal of cardiology. 2006;113(2):283-4.11.Behrendt CA, Heidemann F, Haustein K, Grundmann RT, Debus ES. Perkutane endovaskuläre Therapie der infrainguinalen PAVK. Gefässchirurgie. 2016:1-11.12.Simpson EL, Michaels JA, Thomas SM, Cantrell AJ. Systematic review and meta-analysis of additional technologies to enhance angioplasty for infrainguinal peripheral arterial occlusive disease. Br J Surg. 2013;100(9):1128-37.13.Pancholy SB, Joshi P, Shah S, Rao SV, Bertrand OF, Patel TM. Effect of Vascular Access Site Choice on Radiation Exposure During Coronary Angiography: The REVERE Trial (Randomized Evaluation of Vascular Entry Site and Radiation Exposure). JACC Cardiovascular interventions. 2015;8(9):1189-96.14.Meijer WT, Hoes AW, Rutgers D, Bots ML, Hofman A, Grobbee DE. Peripheral arterial disease in the elderly: The Rotterdam Study. Arterioscler Thromb Vasc Biol. 1998;18(2):185-92.15.Murabito JM, Evans JC, Nieto K, Larson MG, Levy D, Wilson PW. Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study. American heart journal. 2002;143(6):961-5.16.Hansson B, Karambatsakidou A. Relationships Between Entrance Skin Dose, Effective Dose and Dose Area Product for Patients in Diagnostic and Interventional Cardiac Procedures. Radiation protection dosimetry. 2000;90(1-2):141-4.17.Berrington de Gonzalez A, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet. 2004;363(9406):345-51.18.Kullo IJ, Rooke TW. CLINICAL PRACTICE. Peripheral Artery Disease. N Engl J Med. 2016;374(9):861-71.19.Ebrahimi R, Uberoi A, Treadwell M, Sadrzadeh Rafie AH. Effect of Low-Frame Invasive Coronary Angiography on Radiation and Image Quality. The American journal of cardiology. 2016;118(2):195-7." @default.
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• W4238791722 date "2019-12-01" @default.
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• W4238791722 title "Radiation Dosage for Percutaneous PAD Treatment is Different in Cardiovascular Disciplines: Results from an Eleven Year Population Based Registry in the Metropolitan Area of Hamburg" @default.
• W4238791722 doi "https://doi.org/10.1016/j.ejvs.2019.06.553" @default.
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