Key result
CO2-guided digital subtraction angiography during endovascular aortic repair achieved 100% technical success with no significant decline in glomerular filtration rate in patients with renal insufficiency.
Why the study?
The study evaluated whether CO2 is a safe and effective vascular roadmap instead of ICM for EVAR, and whether it is feasible for patients with hostile neck anatomy.
Does CO2-guided DSA provide safe and effective imaging for EVAR in patients with renal insufficiency?
Cohort (n=42)
No
Does CO2-guided DSA provide safe and effective imaging for EVAR in patients with renal insufficiency?
CO2-guided DSA is a highly feasible and safe alternative to iodinated contrast for EVAR in patients with renal insufficiency, achieving 100% technical success without worsening renal function.
Hypothesis-generating for CO2 angiography in renal-impaired EVAR; does not yet justify practice change.
Aim: In our study, we aimed not only if CO2 is a safe and effective vascular roadmap for EVAR procedure instead of ICM but if it is a feasible opportunity for patients with hostile neck anatomy as well. Material and Methods: From January 2019 to July 2022, 42 patients with renal insufficiency had elective EVAR procedures for infrarenal abdominal aortic aneurysm in our Cardiovascular Surgery Clinic with CO2-guided DSA. Results: There were no conversions to open surgery or no need for ICM for the CO2-guided DSA. Technical success for CO2 guidance EVAR was 100% with the second shot. There was no decline in GFR values, only one patient showed transient manifestations of CIN without need for hemodialysis. Conclusion: CO2 DSA is a safe and effective technique that can guide not only the standard but endovascular procedures with a hostile neck for renal insufficiency below the diaphragm allowing virtually unlimited images. With modern automated closed systems, CO2-specific complications will be negligible if the operator has experience with the limitations and contraindications of the technique.
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Mola et al. (2022) conducted a cohort in Infrarenal abdominal aortic aneurysm with renal insufficiency (n=42). CO2-guided digital subtraction angiography was evaluated on Pre-postprocedural estimated GFR, serum creatinine levels, absence of type I or III endoleak, and periprocedural morbidity and mortality. CO2-guided digital subtraction angiography during endovascular aortic repair achieved 100% technical success with no significant decline in glomerular filtration rate in patients with renal insufficiency.
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