Multicentre Evaluation of an Extra Low Dose Protocol to Reduce Radiation Exposure in Superior Mesenteric Artery Stenting

Objective: Radiation dose in mesenteric stenting (MS) remains under evaluated. Yet, MS can lead to high levels of radiation mainly because lateral angulation is needed. The aim of this study was to evaluate the efficacy of an extra low dose protocol (ELDP) to reduce radiation exposure in MS.

Methods: From November 2017 to November 2019, all patients presenting with either acute or chronic atherosclerotic mesenteric ischaemia treated by antegrade MS using either fixed or mobile imaging systems in three university hospitals were included. In November 2018, an ELDP including ≤3 frames/s fluoroscopy and digital subtraction angiography (DSA) was introduced. Prospectively enrolled ELDP patients (Nov 2018-Nov 2019) were compared with retrospectively captured patients (Historical group, Nov 2017-Nov 2018). Radiation data including dose area product (DAP), cumulative air kerma (CAK), and fluoroscopy time (FT) were analysed.

Results: Overall, 46 patients (median age 73 years [63-72], 59% males) were included (ELDP group, n = 21; Historical group, n = 25). Thirty-three patients (72%) underwent MS in a hybrid room. Median DAP (ELDP group, 10 [4.7-26] Gy.cm²vs. Historical group, 45 [24-88] Gy.cm², p = .002), median CAK (ELDP group, 170 [58-260] vs. Historical group, 262 [152-460], p = .037), and median number of DSA runs (ELDP group, 4 [1.5-5] vs. Historical group, 5.5 [3.7-5], p = .030) were statistically significantly lower in patients receiving the ELDP, whereas median FT (ELDP group, 16 min [11-23] vs. Historical group, 14 min [9-25], p = .71) and technical success (ELDP group, 95%; Historical group, 92%, p = .65) were not statistically significantly different between groups.

Conclusion: MS exposes both patients and physicians to a high ionising radiation dose. Awareness of radiation safety and seeking dose reduction is paramount in these highly irradiating procedures. The use of ELDP significantly reduces radiation without compromising technical success.