@article{1d34a6dc-08dc-42b4-a62c-17751e7e3021,
  abstract     = {{<p>Objective: To evaluate the impact of a systematic, multi-component ultra-low-dose imaging protocol on radiation and contrast exposure during endovascular aortic repair (EVAR) across diverse anatomical complexities. Methods: In this retrospective cohort study, 331 consecutive EVAR procedures at a tertiary vascular center were analyzed. Patients treated with an integrated ultra-low-dose protocol (Group A, n = 228) incorporating 2D/3D fusion navigation, low-frame-rate fluoroscopy (3.75 frames/s), restricted digital subtraction angiography (DSA), structured collimation, and routine CO<sub>2</sub> angiography were compared with historical controls treated with a standard low-dose protocol (Group B, n = 103) where the frame rate was the same and CO<sub>2</sub> was only used for fusion registration. Primary endpoint was total dose-area product (DAP). Secondary endpoints included component DAP values, fluoroscopy time, contrast volume, and technical success. Results: Group A demonstrated a 71% reduction in median total DAP (57.9 vs. 199.3 Gy·cm<sup>2</sup>, p &lt; 0.001), driven primarily by an 79% reduction in DSA-associated and 45% fluoroscopy-associated radiation. Contrast volume decreased by 20% (101 vs. 126 mL, p &lt; 0.001) without increased fluoroscopy time (57 vs. 64 s, p = 0.278). Technical success remained comparable (86% vs. 87%, p = 0.809). Reductions were consistent across all repair types, most pronounced in infrarenal repairs with iliac-branch-devices (70% DAP reduction). Within Group A, a dose–response relationship was evident: procedures with ≥70% ultra-low-dose DSA utilization achieved 61% lower radiation than those with &lt;70% adherence. Conclusions: A protocolized, system-level ultra-low-dose imaging workflow achieves substantial, durable reductions in radiation and contrast exposure during EVAR of varying complexity without compromising technical success. This integrated approach represents a scalable strategy for enhancing safety for patients and procedural staff alike.</p>}},
  author       = {{Singh, Bharti and Sadat, Umar and Karelis, Angelos and Sonesson, Björn and Dias, Nuno V.}},
  issn         = {{2077-0383}},
  keywords     = {{ALARA principle; contrast volume; dose-area product; endovascular aortic repair; fusion imaging; occupational exposure; radiation dose; workflow optimization}},
  language     = {{eng}},
  number       = {{10}},
  publisher    = {{MDPI AG}},
  series       = {{Journal of Clinical Medicine}},
  title        = {{An Optimized Ultra-Low-Dose Imaging Protocol for Endovascular Aortic Repair Significantly Reduces Radiation and Contrast Exposures}},
  url          = {{http://dx.doi.org/10.3390/jcm15103796}},
  doi          = {{10.3390/jcm15103796}},
  volume       = {{15}},
  year         = {{2026}},
}