Overhead Arm Support Reduces Radiation Exposure During Complex Endovascular Aortic Repair

145 patients were included in the study, with 43 (30%) undergoing F/BEVAR with arms supported overhead. No differences were identified in age, Body-Mass-Index, aneurysm size, or history of prior aortic intervention between the groups with and without use of OAS. History of dissection (23% vs 7.8%, P=0.01) occurred more frequently among patients treated with their arms-up. Arm elevation was associated with a significant reduction in mean radiation exposure (2261 vs 3100 mGy, P=.01). No difference was observed in fluoroscopy time or volume of contrast used between the two groups. Importantly, no patients experienced palsy of the brachial plexus. Fifty-five (38%) patients required brachial arterial access, limiting the ability to elevate both arms. In subgroup analysis, patients without brachial access continued to show a significant reduction in radiation with arm elevation (2159 vs. 3179 mGy, P<.01) CONCLUSION: Elevation of a patient's arms above their head using OAS during F/BEVAR offers a low-cost, simple strategy that results in a 30% reduction in radiation exposure without added complication. This technique improves visualization and reduces radiation exposure for patients and physicians and should be included in abdominal aortic and visceral work to improve patient and surgeon safety.