According to a study published in the Circulation journal, an acute DNA damage response may occur in operators who perform fluoroscopically guided aortic procedures. The investigators that aimed at measuring DNA damage/repair markers in operators performing endovascular aortic repair (EVAR) highlight the protective effect of leg shielding.

In this study, expression of the DNA damage/repair marker, gamma-H2AX and DNA damage response marker, phosphorylated ataxia telangiectasia mutated (pATM) were quantified in circulating lymphocytes in operators during the peri-operative period of endovascular (infrarenal, branched, and fenestrated) and open aortic repair using flow cytometry. On the other hand, these markers were separately measured in the same operators but this time with leg lead shielding on, along with upper body protection. Comparison was done with those operating with unprotected legs. The results demonstrated that gamma-H2AX and pATM levels increased remarkably in operators immediately after branched EVAR/fenestrated EVAR. Only pATM levels increased after infrarenal EVAR. Expression of both the markers reduced to baseline in operators after 24 hours. No change was seen in gamma-H2AX or pATM expression after open repair. Leg protection abrogated gamma-H2AX and pATM response after branched EVAR/fenestrated EVAR. The expression of gamma-H2AX varied considerably when operators’ blood was exposed to the same radiation dose in vitro.