Objectives and design: The aim of this work was to assess absorbed radiation doses in selected organs and to estimate cancer and mortality risks in patients undergoing abdominal stent-graft implantation, as a function of age, gender, and anatomical parameters of patients' aneurysms and arteries.
Materials and methods: 297 patients (266 males and 31 females) underwent endovascular aortic aneurysm repair (EVAR) with abdominal stent-graft implantation. Kerma-area products Gy-cm(2) for all implanted patients were collected retrospectively. Entrance surface air kerma (ESAK), doses absorbed by selected organs, and cancer/mortality risks were estimated using Monte Carlo simulation methods (CALDose_X software).
Results: The highest radiation doses were deposited in the skin, gallbladder wall, and colon wall. The highest average cancer risk was found for the youngest group of patients (<60 years old; 1:275) and the lowest for the oldest (>70 years old, 1:735). The radiation-induced risk of cancer mortality (mortality risk) was about 40% lower than radiation-induced cancer occurrence risk. Aneurysm neck angulations >45° had a significant impact on ESAK, as well as increasing cancer and mortality risks.
Conclusions: The main factors increasing cancer risk are young age and aneurysm neck angulations >45°, which determines the difficulty of proper stent-graft placement. However, the radiation risk associated with the stent-graft implantation procedure is relatively low, and EVAR should not be avoided.
Keywords: Aneurysm; Endovascular aortic aneurysm repair (EVAR); Organ dose assessment; Radiation risk; Stent-graft implantation.
Copyright © 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.