A Narrative Review of Intraoperative Adjuncts and Techniques to Minimize Radiation During Complex Endovascular Aneurysm Repair.

Background Radiation exposure is a known risk to both patients and providers during endovascular aortic repair (EVAR). Complex EVAR procedures, such as fenestrated and branched EVAR (FBEVAR), inherently involve longer fluoroscopy times and increased radiation doses. While adhering to the as low as reasonably achievable (ALARA) principles and ensuring appropriate personal protective equipment for all operating room staff remains essential, the use of intraoperative techniques and adjuncts to reduce radiation specifically during complex EVAR is necessary. This review aims to summarize intraoperative radiation reduction techniques to provide valuable insights to vascular surgeons and interventional proceduralists to enhance radiation safety during complex EVAR. Methods This review focused on intraoperative techniques and adjuncts that have been used to reduce intraoperative radiation exposure to patients and operators. Published and presented preclinical results, prospective and retrospective study data, and future directions are presented. Results We highlight several intraoperative adjuncts and techniques for reducing radiation exposure during complex EVAR including image fusion, digital zooming, intravascular ultrasound (IVUS), Fiber Optic RealShape technology (FORS), and robotic navigation systems. Short-term outcomes suggest that these techniques are safe, feasible, and effective and decrease radiation exposure to both patients and operators. Conclusions Reducing radiation exposure during complex EVAR remains of critical importance. The presented techniques offer promising avenues for significantly reducing radiation exposure to both patients and providers while maintaining procedural efficacy during complex EVAR.