{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:33:10Z","timestamp":1760059990624,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T00:00:00Z","timestamp":1753401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Peripheral endovascular intervention (PEVI) is routinely performed using standard-dose radiation (SDR), which is associated with elevated levels of radiation. No study has evaluated the outcomes of minimal-dose radiation (MDR) in PEVI. Methods: We performed a prospective observational study of 184 patients (65 \u00b1 12 years) at an academic medical center from January 2019 to March 2020 (mean follow-up of 3.9 \u00b1 3.6 months) and compared the outcomes of MDR (n = 24, 13.0%) and SDR (n = 160, 87.0%) in PEVI. Primary endpoints included air kerma, dose area product (DAP), fluoroscopy time, and contrast use. Secondary endpoints included all-cause mortality, cardiac mortality, acute myocardial infarction, acute kidney injury, stroke, repeat revascularization, vessel dissection\/perforation, major adverse limb event, access site complications, and composite of complications. Results: For MDR (68 \u00b1 10 years, mean follow-up of 4.3 \u00b1 5.2 months), the primary endpoints were significantly less than SDR (65 \u00b1 12 years, mean follow-up of 3.8 \u00b1 3.2 months; p &lt; 0.001). Regarding the secondary endpoints, one vessel dissection occurred using MDR, while 36 total complications occurred with SDR (p = 0.037). Conclusions: PEVI using MDR was safe and efficacious. MDR showed a significant decrement in radiation parameters and fluoroscopy time. Therefore, MDR can serve as an effective alternative for PEVI in acute or critical limb ischemia.<\/jats:p>","DOI":"10.3390\/jcdd12080284","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T14:40:02Z","timestamp":1753454402000},"page":"284","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Application and Outcomes of Minimal-Dose Versus Standard-Dose Radiation in Peripheral Endovascular Intervention (KAR Endovascular Study)"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3105-1874","authenticated-orcid":false,"given":"Subrata","family":"Kar","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX 79905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clifton","family":"Espinoza","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX 79905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e003273","DOI":"10.1161\/CIRCINTERVENTIONS.115.003273","article-title":"Occupational Health Risks in Cardiac Catheterization Laboratory Workers","volume":"9","author":"Andreassi","year":"2016","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_2","first-page":"647","article-title":"Radiation-associated lens changes in the cardiac catheterization laboratory: Results from the IC-CATARACT (CATaracts Attributed to RAdiation in the CaTh lab) study","volume":"91","author":"Karatasakis","year":"2018","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.ejmp.2017.10.007","article-title":"Eye lens dosimetry and the study on radiation cataract in interventional cardiologists","volume":"44","author":"Matsubara","year":"2017","journal-title":"Phys. Med."},{"key":"ref_4","first-page":"1","article-title":"Risk of cataract among interventional cardiologists and catheterization lab staff: A systematic review and meta-analysis","volume":"90","author":"Elmaraezy","year":"2017","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1016\/j.amjcard.2012.12.060","article-title":"Brain and neck tumors among physicians performing interventional procedures","volume":"111","author":"Roguin","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_6","first-page":"913","article-title":"Occupational health hazards of interventional cardiologists in the current decade: Results of the 2014 SCAI membership survey","volume":"86","author":"Klein","year":"2015","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.ahj.2008.08.009","article-title":"Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: Insights from the National Research Council\u2019s Biological Effects of Ionizing Radiation VII Report","volume":"157","author":"Venneri","year":"2009","journal-title":"Am. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.jvs.2015.08.051","article-title":"Radiation exposure to eye lens and operator hands during endovascular procedures in hybrid operating rooms","volume":"63","author":"Attigah","year":"2016","journal-title":"J. Vasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.avsg.2015.11.019","article-title":"Radiation Exposure during Percutaneous Transluminal Angioplasty for Symptomatic Peripheral Arterial Disease","volume":"33","author":"Sigterman","year":"2016","journal-title":"Ann. Vasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1148\/radiol.2542082312","article-title":"Fluoroscopically guided interventional procedures: A review of radiation effects on patients\u2019 skin and hair","volume":"254","author":"Balter","year":"2010","journal-title":"Radiology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.jvs.2014.03.236","article-title":"Radiation-induced skin injury after complex endovascular procedures","volume":"60","author":"Kirkwood","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"187","DOI":"10.25270\/jic\/18.00332","article-title":"Efficacy of Low-Dose Compared with Standard-Dose Radiation for Cardiac Catheterization and Intervention (KAR RAD Study)","volume":"31","author":"Kar","year":"2019","journal-title":"J. Invasive Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.ejvs.2024.07.041","article-title":"Editor\u2019s Choice\u2014Major Adverse Limb Events in Patients Undergoing Revascularisation for Lower Limb Peripheral Arterial Disease: A Nationwide Observational Study","volume":"68","author":"Amlani","year":"2024","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bax, M., Romanov, V., Junday, K., Giannoulatou, E., Martinac, B., Kovacic, J.C., Liu, R., Iismaa, S.E., and Graham, R.M. (2022). Arterial dissections: Common features and new perspectives. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1055862"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e121","DOI":"10.1016\/j.hlc.2019.03.008","article-title":"Contemporary Management of Coronary Artery Perforation","volume":"28","author":"May","year":"2019","journal-title":"Heart Lung Circ."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1038\/ki.2014.328","article-title":"The definition of acute kidney injury and its use in practice","volume":"87","author":"Thomas","year":"2015","journal-title":"Kidney Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e011245","DOI":"10.1161\/JAHA.118.011245","article-title":"Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"7","author":"Katsanos","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.jcin.2018.11.005","article-title":"Patient Radiation Dosage During Lower Extremity Endovascular Intervention","volume":"12","author":"Goldsweig","year":"2019","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1016\/j.jvs.2013.06.016","article-title":"Patient radiation exposure during percutaneous endovascular revascularization of the lower extremity","volume":"58","author":"Segal","year":"2013","journal-title":"J. Vasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1177\/1708538114549592","article-title":"Using 7.5 frames per second reduces radiation exposure in lower extremity peripheral vascular interventions","volume":"23","author":"Akkus","year":"2015","journal-title":"Vascular"}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/8\/284\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:16:09Z","timestamp":1760033769000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/12\/8\/284"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,25]]},"references-count":20,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcdd12080284"],"URL":"https:\/\/doi.org\/10.3390\/jcdd12080284","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2025,7,25]]}}}