Systematic review on radiation-induced DNA damage and cancer risk in endovascular operators

Objective: Endovascular interventions have increasingly replaced open surgery owing to their minimally invasive nature and benefits such as faster recovery and fewer wound complications. This shift has led to greater reliance on fluoroscopy, raising concerns about occupational radiation exposure. Ionizing radiation, although essential for guiding procedures, can damage living tissue and potentially induce long-term health effects. Recent guidelines from the European Society for Vascular Surgery and the Cardiovascular and Interventional Radiological Society of Europe emphasize growing radiation risks and advocate for dose optimization and protective strategies. Endovascular specialists—vascular surgeons, interventional cardiologists, and radiologists—are among the most exposed hospital staff. Yet, limited studies have specifically examined the effects of fluoroscopy-induced DNA damage and carcinogenesis in these professionals. The aim of this systematic review was to evaluate the extent to which occupational radiation exposure contributes to DNA damage and cancer risk in endovascular operators. Methods: A systematic search of the literature from 2000 to April 2025 of PubMed and EMBASE was conducted following the PRISMA guidelines. All experimental studies, observational studies, and case reports that examined DNA damage or cancer occurrence in operators performing endovascular procedures owing to occupational radiation exposure were included in this review. Studies were categorized into two primary outcomes: cancer and DNA damage. A risk of bias assessment was performed according to Cochrane guidelines. Results: Twenty-five studies were identified. The findings from these studies suggest that occupational radiation exposure in endovascular operators may lead to early-stage DNA damage shortly after exposure. Additionally, the studies observed chronic DNA damage, including double-strand DNA breaks and chromosomal aberrations, which are hypothesized to be a contributing factor to genomic instability and carcinogenesis. Furthermore, the studies researching carcinogenesis suggest an increased risk of cancer development in endovascular operators, with particular emphasis on cancer localizations that are more susceptible to radiation, such as leukemia and thyroid cancer, and in unprotected body areas, such as the skin and the brain. Conclusions: This systematic review suggests that endovascular operators involved in fluoroscopy-guided interventional procedures may face an increased risk of stochastic health effects, with a particular emphasis on chronic DNA damage and carcinogenesis in locations more vulnerable to radiation. This review highlights the critical need for enhanced radiation safety measures, awareness, and preventative strategies.