Abstract No. 97: Evaluation of a two-stage approach for insertion of the hemodialysis reliable outflow (HeRO) vascular access device in patients with central venous occlusion

sure in dialysis patients who often present to interventional radiology multiple times over the course of their disease, requiring both line placement and evaluation of dialysis circuits without understanding of cumulative dose. Materials and Methods: Our QI database was queried for patients undergoing dialysis acess evaluation between July 1st to October 1st, as this was when we began recoding fluoroscopic dose in dose area product (DAP) in the medical record. A retrospective chart review of 37 consecutive patients was performed to determine the total number of dialysis interventions performed extending back to the beginning of electronic medical records in 2007. Based on the data obtained from July to October 2011, an average DAP was calculated per procedure type, namely dialysis circuit evaluations (which included graft declots and fistulograms) and dialysis line placements for access issues. This calculated DAP was used to estimate a total cumulative radiation dose based on the total number of procedures performed per patient. Results: A total of 37 patients with a mean age of 54, range 21-96 years old, were evaluated. 59.5% of these patients were 50 years old. The mean number of dialysis circuit evaluations per patient was 5 with a range of 1-30. The mean number of dialysis line placements per patient was 3 with a range of 0-17. The average estimated dose per procedure was 29.1 Gy-cm2 for dialysis circuit evaluations and 6.38 Gy-cm2 for dialysis line placement. For comparison, 2 dialysis circuit evaluations is similar to 1 coronary angiogram (mean 60.2 Gy-cm2). Overall, the average estimated cumulative dose per patient over the course of multiple dialysisrelated procedures in IR was 164 Gy-cm2 (range 29-886 Gy-cm2). Conclusion: Although more prospective data is required, it seems clear through a brief evaluation of a single institution’s dialysis patients, that cumulative radiation dosage to this subset of patients over time and multiple repeat procedures is significant. Further evaluation of how to longitudinally track and limit radiation dosage to this challenging group of patients is required to minimize potential long-term stochastic effects.