72216 - Diagnostic reference level for endovascular abdominal aortic aneurysm repair in Sweden

Introduction The 2023 ESVS guidelines on Radiation Safety recommends establishment of national diagnostic reference level (DRLs) for endovascular procedures. (1) Diagnostic reference level is a tool used for medical imaging procedures using ionizing radiation for optimization and reference. (2) (3) (4). The aim of this study was to propose a national DRL for Sweden for standard EVAR procedure. Method All standard EVAR procedures performed in Sweden 2021-2022 were identified in SwedVasc. The EVARs were then grouped into intact and ruptured cases and then further subgrouped. Radiation data was analysed for the whole cohort with subgroup analysis for ruptures and obesity (BMI>25). The preliminary national DRL for standard EVARs was determined as the third quartile of the DAP median values from all centers. Result A total of 1423 EVAR procedures performed at 26 centers in Sweden were identified. Twenty centers have agreed to participate, data from 13 centers were included in the preliminary data review. Remaining 7 centers are still collecting data. A total of 508 EVAR procedures were included into this preliminary analysis. The correlation between DAP value and individual center volume was non-significant, p=0.1 (Figure 2). The proposed preliminary DLR for standard EVAR (n=403) was 153 Gy cm2. Mean DAP for patients with BMI <25 and ≥25 was 75 and 148 respectively (p-<0.001). Mean DAP for ruptures (n=63) and intact AAA (n=462) was 187 and 131 respectively (p=0.002). Discussion An evaluation and further a continuous reassessment of the national DRLs are in order to keep the radiation doses as low as reasonably possible.