Techniques to reduce radiation for patients and operators during aortic endografting.

Endovascular aortic repair of aortic pathologies has become widely spread among vascular surgeons. Much focus has been directed at perfecting and developing endovascular procedures to treat evermore-complex issues. Much less focus has been directed at the radiation hazards to patients as well as operators and staff when such procedures are performed. Radiation exposure must be used according to the ALARA (As low As Reasonably Achievable) principle to avoid short- and long-term negative side effects. Modern imaging technology offers many technological developments to reduce radiation such as low dose programs, pulsed imaging, flat-panel technology and advanced intraoperative imaging techniques. But beside this, simple measures, based on the understanding of radiation exposure, can easily be implemented in everyday standard practice. Appropriate shielding of patients and staff, using adjuncts to be able to keep a safe distance to the radiation source and avoiding to work with inappropriate C- arm angulations should be used routinely. Continued education of vascular surgeons is imperative to implement changes in practice to reduce radiation exposure.