Endovascular Infrarenal Aortic Aneurysm Repair Performed in a Hybrid Operating Room Versus Conventional Operating Room Using a C-Arm

Background: To compare contrast usage and radiation exposure during endovascular aneurysm repair (EVAR) using mobile C-arm imaging in a conventional operating room (OR) or fixed angiographic equipment in a hybrid OR (HR). Methods: A retrospective unicenter study from May 2016 to August 2019. All consecutive patients undergoing standard EVAR were included. Patients were divided into 2 groups. Group OR included EVARs performed in a conventional OR with a mobile C-arm (May 2016 to April 2018) and group HR included EVARs performed with a fixed angiographic equipment in an HR (May 2018 to August 2019). Data collected included patient demographics, aneurysm diameter, neck length, radiation dose: median dose-area product (DAP), fluoroscopy time, total operative time, contrast use, and 30-day clinical outcomes. Results: A total of 77 patients were included in the study (42 patients in group OR and 35 patients in group HR). There was no difference in age, body mass index (BMI), mean aneurysm, and neck length between groups. Patients in the group HR received less contrast volume (108.6 mL [+/- 41.5] vs. 162.5 mL [+/- 52.6]; P < 0.001), but higher radiation dose (154 Gy cm(2) [+/- 102.9] vs. 61.5 Gy cm(2) [+/- 42.4]; P < 0.001). There were no differences in fluoroscopy time (20.4 min [+/- 8.5] vs. 23.2 min [+/- 12.4]; P = 0.274) and total operative time (106.4 [+/- 22.3] vs. 109.4 [+/- 25.8]; P = 0.798). No difference was found in terms of 30-day complication rates or operative mortality between groups. DAP was positively correlated with BMI in the group OR (Spearman's rank correlation coefficient r(s), 0.580; P < 0.001), but no correlation could be seen in the group HR (r(s), 0.408; P = 0.028). Conclusions: Routine EVAR performed in a hybrid fixed-imaging suite may be associated with less contrast usage, but higher radiation exposure in our center. The significantly higher radiation exposure when the mobile C-arm is replaced by an HR should not be underestimated.