A study published in Circulation has shown for the first time that an acute DNA damage response occurs in operators performing fluoroscopically-guided interventions such as endovascular aortic repair (EVAR). Leg shielding may have a protective effect though, the researchers said.
DNA damage/repair markers were measured in circulating lymphocytes of operators at several times—before performing endovascular and open aortic repairs, immediately after the procedure, and 24 hours after the procedure. The markers used to quantify the DNA damage were gamma-H2AX (γ-H2AX) and phosphorylated ataxia telangiectasia mutated (pATM).
Immediately after operators performed branched or fenestrated endovascular aortic repair (BEVAR/FEVAR), levels of both markers significantly increased. Following infrarenal (IEVAR) repair though, only levels of the pATM marker rose.
Operators reached baseline expression of both markers 24 hours after performing the procedures. After performing open repair, there was no recorded change in either marker, confirming that the effect is linked to radiation exposure.
The authors noted that the expression of γ-H2AX had significant variations between operators when their lymphocytes were irradiated in vitro. This means that susceptibility to radiation damage may differ between individuals.
Also notable was the importance of wearing leg protection. “The stark findings of the present study specifically highlight the importance of using leg leaded pads, by demonstrating that the markers of DNA damage detected in operators’ circulating lymphocytes were absent when the operator wore additional lower leg lead shielding,” they wrote.
“Operators often neglect to wear lower leg lead shielding, viewing its use as cumbersome and unnecessary, but the present data highlight the importance of protecting the legs,” they concluded.
El-Sayed T, Patel A, Cho JS. Radiation induced DNA damage in operators performing endovascular aortic repair. Circulation. 2017 Oct 20. pii: CIRCULATIONAHA.117.029550. doi: 10.1161/CIRCULATIONAHA.117.029550. [Epub ahead of print].