Radiation exposure in an endovascular aortic aneurysm repair program after introduction of a hybrid operating theater

Bryan Wermelink*, Edith M. Willigendael, Casper Smit, Roland J. Beuk, Robbert Meerwaldt, Robert H. Geelkerken, Marjolein G.J. Brusse-Keizer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
56 Downloads (Pure)


Background: A hybrid operating theater (HOT) enables optimal image quality, improved ergonomics, and excellent sterility for complex endovascular and hybrid procedures. We hypothesize that the commissioning of a new HOT involves a learning curve. It is unclear how steep the learning curve of these advanced HOTs is. The main purpose of this research was to evaluate radiation exposure parameters in a new HOT for a team of vascular surgeons experienced with infrarenal endovascular aneurysm repair (EVAR) procedures in a conventional operating room with a mobile C-arm. In addition, a comparison of the dose-area product (DAP) achieved in this study and in the literature was made. Methods: Before commissioning of the HOT, four vascular surgeons completed a comprehensive HOT training program. From the commissioning of the HOT, clinical and procedural data for all consecutive acute and elective patients treated with EVAR were retrospectively collected for a period of 18 months (January 2016-June 2017). A literature review was conducted of the dose-area product in EVAR procedures performed with a dedicated fixed system or mobile C-arm to analyze how this study performed compared with the literature. Results: In the 18-month study period, 77 patients were treated with EVAR (59 electively and 18 acutely), from whom the data were obtained. There was no significant change in radiation exposure parameters over time. From the commissioning of the HOT, EVAR procedures were performed with radiation exposure parameters similar to those of studies found in experienced vascular centers using fixed systems. Conclusions: Concerning radiation exposure parameters, the commissioning of a new HOT was not accompanied by a learning curve. Radiation exposure parameters achieved in this study were similar to those of studies from experienced and dedicated vascular centers.

Original languageEnglish
Pages (from-to)1927-1934.e2
JournalJournal of vascular surgery
Issue number6
Early online date18 Jul 2019
Publication statusPublished - Dec 2019


  • Dose-area product
  • Endovascular aneurysm repair
  • Hybrid operating theater
  • Learning curve
  • Radiation parameters
  • 22/4 OA procedure


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