Effects of the Institutional Volume of Endovascular Treatment for Lower Extremity Artery Disease on Radiation Exposure.

PURPOSE: The procedure time of endovascular treatment (EVT) for lower extremity artery disease (LEAD) may increase as its application expands to more complex lesions. Given this trend and the growing importance of radiation protection, this study investigated the association between annual institutional EVT volume and radiation exposure in patients with LEAD. METHODS: Data from 1638 cases of EVT for LEAD were collected from 167 institutions between April 2020 and March 2022. The locations of treated vascular lesions were classified into 3 anatomical segments: aortoiliac (AI), femoropopliteal (FP), and below-the-knee (BTK) regions. Institutions were categorized as a high-volume group (≥147 EVT cases/year) or low-volume group (<147 EVT cases/year). Propensity score matching was performed using the following covariates: age, sex, body mass index, number of digital angiography and digital subtraction angiography acquisitions, the presence of chronic total occlusion, and fluoroscopy dose rates. The primary endpoints were air kerma at the entrance reference point (Ka,r), air kerma area product (PKA), and fluoroscopy time (FT). RESULTS: Fluoroscopy time was significantly shorter in all regions in the high-volume group (AI: 21.0 vs 33.8 minutes, P = .043; FP: 20.3 vs 28.2 minutes, P = .022; BTK: 30.6 vs 34.9 minutes, P = .009). No significant differences were observed in Ka,r or PKA in any regions between the groups. CONCLUSION: In EVT for LEAD, FT was significantly shorter in high-volume institutions, whereas cumulative radiation dose metrics did not differ significantly. These findings suggest that radiation exposure is influenced by multiple technical and patient-related factors. Optimizing radiation exposure therefore requires not only reducing FT but also implementing comprehensive dose management strategies, including standardization of imaging protocols, equipment settings, and education in radiation techniques.Clinical ImpactThis study demonstrates that institutions performing a higher annual volume of endovascular treatments (EVT) for lower extremity artery disease achieve significantly shorter fluoroscopy times compared with lower-volume centers, although no significant differences were observed in radiation dose indicators such as Ka,r and PKA. These findings highlight that procedural efficiency gained through institutional experience does not necessarily translate into reduced radiation exposure, as total dose is influenced by multiple factors including imaging conditions, equipment parameters, and patient characteristics. From a clinical perspective, this underscores the importance of comprehensive dose management strategies that extend beyond reducing fluoroscopy time, incorporating the standardization of imaging protocols, optimization of device settings, and continuous education on radiation safety. The present results provide new evidence to guide radiation protection practices in EVT and support the establishment of cross-institutional benchmarks for safer and more effective patient care.