Lens Radiation Exposure During Total Aortic Arch Repair With Double-Fenestrated Physician-Modified Stent Graft: A Prospective Study

Abstract

Objective:

The aim of this report is to quantify the radiation exposure of each person present in the operating room, with a focus on lens exposure, during total aortic arch repair using double-fenestrated PMEG (physician-modified endograft).

Methods:

Prospective, nonrandomized single-center study design. Radiation data from 22 procedures of aortic arch repair with double-fenestrated PMEG from February to June 2025 were analyzed. Patient dose information was collected by the imaging equipment. Real-time dosimetry was used to collect exposure data to the lens for the operators, first assistant, and anesthesiologist. The endpoints are overall equivalent doses and lens exposure.

Results:

A total of 11 patients were treated for arch aneurysm and 11 for chronic dissection. Mean body mass index (BMI) of the patient is 26.4 kg/m² (SD=3.5). Mean radiation time is 10 minutes (SD=4.4), median total radiation is 180 dGy.cm² (IQR=150), and air Kerma is 49 mGy (SD=81). Received lens doses are respectively for the main operator, the first assistant, and the anesthetist of 6.4 μSv (IQR=6.6), 0.62 μSv (IQR=0.67), and 2 μSv (IQR=2.02). Dose of iodine contrast injected was 40 mL in all patients. Radiation exposure was significantly higher when BMI was over 27 kg/m².

Conclusion:

Radiation protection is a critical concern for vascular surgeons as complex endovascular procedures routinely deliver measurable radiation to the eyes. Double-fenestrated PMEG is an endovascular solution for total aortic arch repair with acceptably low radiation exposure, particularly to the lens.

Clinical Impact

This study presents the results on 22 patients treated with double-fenestrated PMEG, with prospectively collected data on radiation exposure (overall and to the lens). It suggests that total aortic arch repair is feasible with acceptably low radiation exposure to both the patient and the operating room staff (main operator, first assistant, and anesthetist), especially regarding the lens exposure.