Radiation Induced DNA Damage in Operators Performing Endovascular Aortic Repair - Journal of Vascular Surgery

This study detects an acute DNA damage response in operators performing fluoroscopically-guided aortic procedures and highlights the protective effect of leg shielding. Defining the relationship between this response and cancer risk may better inform safe levels of chronic low dose radiation exposure. Radiation exposure during fluoroscopically-guided interventions such as endovascular aortic repair (EVAR) is a growing concern for operators. This study aimed to measure DNA damage/repair markers in operators performing EVAR. Expression of the DNA damage/repair marker, gamma-H2AX (y-H2AX) and DNA damage response (DDR) marker, phosphorylated ataxia telangiectasia mutated (pATM), were quantified in circulating lymphocytes in operators during the peri-operative period (before, immediately after, 24 hours after) of endovascular (infrarenal [EVAR], branched [BEVAR] and fenestrated [FEVAR]) and open aortic repair using flow cytometry. Overall number of cases were 45 (15 EVAR, 16 BEVAR/FEVAR, 14 open AAA repair). Personal dosimetry demonstrated minimal exposure under the operators protective lead garment but higher exposure over the lead (P < .0001), particularly at the lower leg (P < .0001). These markers were separately measured in the same operators but this time wearing leg lead shielding in addition to upper body protection and compared with those operating with unprotected legs. Susceptibility to radiation damage was determined by irradiating operators' blood in vitro. The y-H2AX and pATM levels were absent prior to operation (and during open operation) but increased significantly in operators immediately after BEVAR/FEVAR (P < .0003 for both). Only pATM levels increased after EVAR (P < .04). Expression of both markers fell to baseline in operators after 24hrs (P < .003 for both). There was no change in y-H2AX or pATM expression after open repair. Leg protection abrogated y-H2AX and pATM response after BEVAR/FEVAR with dosimetry demonstrating no difference from control (no leggings) in terms of exposure. Radiation exposure at leg level is almost two-fold higher for BEVAR/FEVAR than for EVAR. The expression of y-H2AX varied significantly when operators' blood was exposed to the same radiation dose in vitro (P < .0001). Every interventionalist is concerned with radiation exposure due to the risk of DNA damage with resultant cancer and/or congenital defects. This is especially true for us performing endovascular abdominal aortic aneurysmal repairs due to the potential for extended periods of radiation exposure. This study confirms a DNA effect from the