National Diagnostic Reference Levels for Endovascular Aneurysm Repair and Optimisation Strategies.

OBJECTIVE: The International Commission on Radiological Protection (ICRP) has highlighted the large number of medical specialties using fluoroscopy outside imaging departments without programmes of radiation protection (RP) for patients and staff. Vascular surgery is one of these specialties and endovascular aneurysm repair (EVAR) is one of the most challenging procedures requiring RP guidance and optimisation actions. The recent European Directive on Basic Safety Standards requires the use and regular update of diagnostic reference levels (DRL) for interventional procedures. The objective of the study was to know the doses of patients undergoing EVAR with mobile Xray systems and with hybrid rooms (fixed Xray systems), to obtain national DRLs and suggest optimisation actions. METHODS: The Spanish Chapter of Endovascular Surgery launched a national survey that involved hospitals for 10 autonomous communities representing the 77% of the Spanish population (46.7 million inhabitants). Patient dose values from mobile Xray systems were available from nine hospitals (sample of 165 EVAR procedures) and data from hybrid rooms, from seven hospitals, with dosimetric data from 123 procedures. The initial national DRLs have been obtained, as the third quartile of the median values from the different centres involved in the survey. RESULTS: The proposed national DRLs are 278 Gy cm2 for hybrid rooms and 87 Gy cm2 for mobile Xray systems, and for cumulative air kerma (cumulative AK) at the patient entrance reference point, 1403 mGy for hybrid rooms, and 292 mGy for mobile systems. CONCLUSION: An audit of patient doses for EVAR procedures to identify optimised imaging protocol strategies is needed. It is also appropriate to evaluate the diagnostic information required for EVAR procedures. The increase by a factor of 3.2 (for kerma area product) and 4.8 (for cumulative AK) in the DRLs needs to be justified when the procedures are performed in the hybrid rooms rather than with mobile Xray systems.

Role of IL-10 promoter polymorphisms in the development of severe aorto-iliac occlusive disease.

Aortic severe occlusive disease (ASO) is a peripheral manifestation of atherosclerosis with an inflammatory component. Interleukin (IL)-10 is an anti-inflammatory cytokine that plays a key role in the development of atherosclerosis, promoting the stability of the atherosclerotic plaque. Several polymorphisms within the 5' region of the IL-10 gene have been related to altered transcriptional activity and protein levels. We aimed at studying two microsatellites, IL-10R and IL-10G, at -4 and -1.2 Kb, and three single nucleotide polymorphisms at positions -1082A/G, -819C/T and -592C/A in a collection of 94 ASO patients and 519 ethnically matched controls. Our results show that the IL-10 proximal promoter haplotype IL-10G*11/ -1082G/ -819C/ -592C is more frequent in ASO patients than in controls (28.7% vs 16% p = 0.003; OR = 2.12). Therefore, our data suggest a role of the IL-10 gene on ASO susceptibility.