Determinants of radiation exposure during EVAR.

OBJECTIVES: Endovascular aneurysm repair (EVAR) is an established method of aortic aneurysm repair, in favourable anatomical configurations. It does however expose patients to radiation. The study aim was to determine if the aneurysm neck morphology influenced radiation exposure. PATIENTS AND METHODS: All elective and emergency EVAR patients were identified. Elective patients had a bifurcated stent-graft deployed, while emergency patients were repaired with an aorto-uni-iliac stent-graft and fem-fem crossover bypass. Proximal and distal aortic neck diameters, neck length, neck angles and sac diameter were recorded, with the radiation dose, screening time and contrast volume. The two subgroups of elective and emergency patients were compared and correlation between anatomical and radiological parameters calculated by using Pearson's correlation coefficient. RESULTS: 320 (270 male) elective patients and 64 (55 male) emergency patients from October 1998 to October 2008 underwent EVAR. The mean proximal (p = 0.004) and distal (p = 0.01) neck diameters were smaller and mean sac diameter (p < 0.0001) was greater in emergencies. No difference between groups existed in the neck length (p = 0.36) and suprarenal diameter (p = 0.30), sagittal (p = 0.05) and coronal (p = 0.62) neck angles. The screening time (p = 0.053) and contrast volume (p = 0.04) were lower, with a slightly higher radiation dose (p = 0.12) in emergencies. There was no definite correlation between the seven anatomical and three radiological parameters. CONCLUSION: While radiation exposure is different in emergency patients, this is thought due to surgical technique rather than the aneurysm neck morphology.

Change in worksite smoking behavior following cancer risk feedback: a pilot study.

OBJECTIVE: To pilot a worksite smoking intervention. METHODS: Following baseline assessment, participants (N=6378) received cancer risk feedback; 2 annual evaluations were conducted. RESULTS: Using all data, smoking dropped from 13.7% to 8.4% and 9.3%, and smoker's readiness to quit increased. Using complete data, smoking initially increased from 5.7% to 6.7%, but subsequently decreased to 5.3%; the increase in smoker's readiness to quit remained. Being male, younger, and with lower education and self-efficacy predicted smoking. Lower age and higher self-efficacy predicted readiness to quit smoking. CONCLUSIONS: These findings support a formal evaluation of a worksite smoking intervention using cancer risk feedback.

The low prevalence of abdominal aortic aneurysm in relatives in Northern Ireland.

INTRODUCTION: Mortality from ruptured abdominal aortic aneurysm (AAA) remains high and has given impetus to screening. Targeted screening towards high-risk groups would increase efficacy. Relatives of previous AAA patients have been suggested as one such group. The aim of this study was therefore to determine the prevalence of AAA in relatives of previous patients in Northern Ireland. PATIENTS AND METHODS: All living AAA patients, who underwent surgery between August 2001 and December 2005 in our unit, or were attending for follow-up of small aneurysms were contacted and asked for details of siblings and their family history. Screening by ultrasound was offered to the siblings and children over 50 years, with a defining threshold diameter for an aneurysm of 3.0 cm. Overall prevalence of AAA in the relatives was calculated. Separate prevalence rates were calculated according to relationship and gender of the patient and relative. RESULTS: 513 previous patients were contacted. 132 gave details of living relatives, resulting in a total of 405 relatives suitable for screening. 105 declined a scan, leaving 300 in the study. Overall mean age of the group was 63.0+/-8.7 years and 68% were siblings of male patients. Overall ten AAAs were detected by screening, giving a prevalence of 3.3%. No aneurysms were found in the subgroup of children, while the highest prevalence (12.5%) was found in brothers of female patients. 20 additional AAAs were reported in these 132 families, resulting in 14 of the 132 families (10.6%) having two or more members with AAA. CONCLUSION: The prevalence of screening detected AAA in this study is lower than anticipated. The reason is unclear, but demonstrates the multifactorial nature of the aetiology and genetic complexities yet to be unravelled by future research.

Buckling of the tethering catheter causes migration of a temporary caval filter to the right atrium.

AIM: To report problems in the tethering catheter shaft of the Tempofilter, temporary caval filter. MATERIALS AND METHODS: Two cases are reported where the tethering catheter shaft of the Tempofilter buckled within the jugular vein. RESULTS: Buckling of the tethering shaft caused cephalic migration of the filter into the right atrium. Both filters were uneventfully removed without adverse sequelae. CONCLUSION: These cases demonstrate another mechanism of tethering shaft shortening which results in unexpected migration of the filter. This device is potentially dangerous because of the liability of the tethering cather to buckle at or near the insertion site with cephalic migration of the filter. Improvements in the tethering catheter mechanism need to be made before further patient usage.

Radiation doses to patients during pharyngeal videofluoroscopy.

Pharyngeal videofluoroscopy (VTF) is a well-recognized technique for investigating and assessing swallowing disorders. There is, however, a paucity of data available regarding the radiation dose to patients during such procedures, but there is general concern that fluorographic imaging modalities are associated with significant radiation exposure. We have recorded the dose received by 23 patients undergoing VTF in our department using a Dose-Area Product (DAP) Meter and have used the data to calculate the effective dose to the patients. The mean effective dose is 0.4 mSv (range 0.027-1.1) which compares favorably with the effective doses associated with other common radiological procedures. We therefore conclude that the radiation detriment associated with pharyngeal VTF is well within acceptable levels.

Conscious sedation and analgesia for routine aortofemoral arteriography: a prospective evaluation.

PURPOSE: To compare the effectiveness of temazepam and midazolam hydrochloride with or without fentanyl citrate versus a placebo in promoting patient acceptance of diagnostic aortofemoral arteriography. MATERIALS AND METHODS: One hundred twenty-five patients undergoing aortofemoral arteriography were prospectively and randomly assigned to one of four treatment arms: placebo (group A), oral temazepam (group B), intravenous midazolam (group C), or intravenous midazolam and fentanyl (group D). Patients were blinded to the administered sedative. Five-point scales were used to assess degree of patient discomfort, willingness to undergo the same procedure again, patient compliance, and preprocedural anxiety. RESULTS: There was no difference between patient groups in willingness to return for a repeat procedure (P: =.89). Group C patients were less compliant during the procedure (P: =.034). Mean patient discomfort scores were 1.81 for group A, 1.84 for group B, 1. 53 for group C, and 1.27 for group D. Discomfort experienced during the procedure was not related to the degree of preprocedural anxiety (P: =.42). Patients who had previously undergone arteriography reported a higher level of pain than did those who had not (P: =. 021). CONCLUSION: Most patients experienced only low-level discomfort during diagnostic aortofemoral arteriography. In the authors' opinion, conscious sedation should only be used selectively, not routinely, for diagnostic aortofemoral arteriography.