Fluoroscopy Time and Radiation Exposure in TEVAR Versus EVAR: A Systematic Review and Meta-Analysis
Abstract
Background: Ionizing radiation exposure is inherent to endovascular surgery and is associated with adverse health effects. This systematic review and meta-analysis compared patient radiation exposure during endovascular aneurysm repair (EVAR) and thoracic endovascular aneurysm repair (TEVAR), focusing on fluoroscopy time (FT), kerma-area product (KAP), and cumulative air kerma (CAK).
Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant search of MEDLINE, Scopus, and the Cochrane Library (June 2015-June 2025) identified English-language studies with ≥20 patients reporting FT, KAP, or CAK during elective EVAR or TEVAR. Pooled means with 95% confidence intervals were calculated using random-effects modeling. Risk of bias was assessed with ROBINS-I version 2 and publication bias with Egger's test and funnel plots.
Results: Seventy-eight studies (73 EVAR and 5 TEVAR) met inclusion criteria. TEVAR demonstrated significantly shorter FT than EVAR (15.25 vs. 28.50 min; P 2; P = 0.970) or CAK (804.92 vs. 1,091.03 mGy; P = 0.090). Heterogeneity was high across all outcomes (I2 > 85%). Only 11.5% of studies reported explicit as low as reasonably achievable compliance, and fusion imaging was used in 9%, more frequently in TEVAR. Publication bias was evident for all radiation metrics.
Conclusion: Radiation exposure during EVAR and TEVAR varies substantially, reflecting anatomical complexity, imaging technology, and procedural practice. TEVAR required…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 20 participants or records.
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