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The following is a summary of the “Analysis Of Radiation Exposure In Endovascular Treatment Of Chronic Limb-Threatening Ischemia By Arterial Access And Glass Classification.,” published in the March 2025 issue of the Journal of Vascular Surgery by Carmen et al.

Endovascular therapy for chronic limb-threatening ischemia (CLTI) has advanced significantly with the introduction of novel techniques and devices. However, limited data exist on the radiation exposure associated with CLTI revascularization using different C-arm systems. This study aims to assess radiation dose parameters in relation to arterial access sites and GLASS classification, comparing mobile C-arms (MCA) and hybrid room (HR) systems. A cross-sectional, non-randomized analysis was conducted on endovascular procedures performed for CLTI revascularization, all of which were executed percutaneously using either an MCA or HR system. Procedures were stratified based on the GLASS classification, and arterial access sites included antegrade femoral, contralateral femoral, brachial, and double arterial access (incorporating retrograde approaches). 

The dosimetric parameters evaluated included Air-Kerma Area Product (KAP), fluoroscopy time (FT), Cumulative Air Kerma (CAK), and contrast volume. From July 2020 to September 2023, a total of 465 procedures were performed on 373 patients, with a mean age of 73.4 years (SD: 11.24 years; range: 37–99 years). Analysis revealed that antegrade access was associated with significantly lower median CAK in MCA compared to HR (3.33 Gy vs 6.08 Gy; p < .001). However, median FT was significantly lower in HR than in MCA (795.13 s vs 981 s; p = .039). For contralateral femoral access, the mean KAP was significantly greater in HR compared to MCA (19.22 Gy·cm² vs 13.29 Gy·cm²; p = .028), a trend also observed in double arterial access (17.4 Gy·cm² vs 7.35 Gy·cm²; p = .012). Across all three GLASS classification categories, HR systems were associated with significantly higher mean KAP compared to MCA (p < .05). These findings suggest that antegrade access results in lower radiation exposure compared to other arterial access sites. 

Additionally, infrainguinal revascularizations conducted in HR systems consistently demonstrated higher radiation levels, with significant differences across all access types. This study highlights the importance of optimizing procedural strategies to minimize radiation exposure, particularly in patients with high-risk populations undergoing complex CLTI revascularization.

Source: jvascsurg.org/article/S0741-5214(25)00616-0/abstract