Radiation Exposure during Recanalisation of Chronic Unilateral Iliofemoral Venous Obstruction Based on Anatomical Classification.

OBJECTIVE

The aim of this study was to evaluate differences in radiation exposure across chronic venous obstruction (CVO) classification groups during endovascular recanalisation and stenting of unilateral iliofemoral lesions and to identify clinical and procedural factors influencing radiation dose.

METHODS

This was a retrospective, single centre cohort study of 133 patients with unilateral iliofemoral CVO who underwent successful endovascular recanalisation and stenting with mobile C arm fluoroscopy between February 2017 and January 2023. Lesions were classified using the Jalaie CVO classification system. Radiation parameters included fluoroscopy time (FT), cumulative air kerma (CAK), kerma area product (KAP), entrance skin dose, and effective dose. Procedure data included total stent length and procedure time. Radiation and procedure parameters were recorded systematically in the institutional database and subsequently analysed across classification groups. Statistical analyses involved Mann-Whitney U test, Pearson and Spearman correlation analyses, and multivariable linear regression.

RESULTS

Radiation exposure increased with higher CVO classification. Type III and IV lesions were associated with longer FT and higher CAK and KAP than type I lesions (p < .001). Compared with single stent implantation, use of two or three stents was associated with higher CAK (p < .001 and p = .006, respectively) and KAP (p < .001 and p = .008, respectively). In multivariable analysis, FT was independently predicted by total procedure time (p < .001) and body mass index (BMI) (p = .024). CAK and KAP were independently predicted by total procedure time (p < .001), BMI (p < .001), total stent length (p = .035 and p = .015), and type IV obstruction (p = .020 and p = .034).

CONCLUSION

Radiation exposure during unilateral iliofemoral CVO intervention increases with lesion severity. CVO type IV, BMI, total stent length, and procedure time were independently associated with radiation dose.