Carbon dioxide (CO2) angiography as an option for endovascular abdominal aortic aneurysm repair (EVAR) in patients with chronic kidney disease (CKD)

Int J Cardiovasc Imaging. 2017 Nov;33(11):1655-1662. doi: 10.1007/s10554-017-1175-2. Epub 2017 May 27.

Abstract

To assess feasibility, efficacy and safety of carbon dioxide (CO2) digital subtraction angiography (DSA) to guide endovascular aneurysm repair (EVAR) in a cohort of patients with chronic kidney disease (CKD). After Ethical Committee approval, the records of 13 patients (all male, mean age 74.6 ± 8.0 years) with CKD, who underwent EVAR to exclude an abdominal aortic aneurysm (AAA) under CO2 angiography guidance, were reviewed. The AAA to be excluded had a mean diameter of 52.0 ± 8.0 mm. CO2 angiography was performed by automatic (n = 7) or hand (n = 6) injection. The endograft was correctly placed and the AAA was excluded in all cases, without any surgical conversions. Two patients (15.4%) had an endoleak: one type-Ia, detected by CO2-DSA and effectively treated with prosthesis dilatation; one type-III, detected by CO2-DSA, confirmed using 10 ml of ICM, and conservatively managed. In one patient, CO2 angiograms were considered of too low quality for guiding the procedure and 200 ml of ICM were administered. Overall, 11 patients (84.6%) underwent a successful EVAR under the guidance of the sole CO2 angiography. No patients suffered from major complications, including those typically CO2-related. Two patients suffered from abdominal pain during the procedure secondary to a transient splanchnic perfusion's reduction due to CO2, and one patient had a worsening of renal function probably caused by a cholesterol embolization during the procedure. In patients with CKD, EVAR under CO2 angiography guidance is feasible, effective, and safe.

Keywords: Abdominal aortic aneurysm (AAA); Angiography; Carbon dioxide (CO2); Chronic kidney disease (CKD); Endovascular aneurysm repair (EVAR); Iodinated contrast material (ICM).

MeSH terms

  • Aged
  • Aged, 80 and over
  • Angiography, Digital Subtraction / adverse effects
  • Angiography, Digital Subtraction / methods*
  • Aortic Aneurysm, Abdominal / complications
  • Aortic Aneurysm, Abdominal / diagnostic imaging*
  • Aortic Aneurysm, Abdominal / therapy*
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Carbon Dioxide / administration & dosage*
  • Carbon Dioxide / adverse effects
  • Contrast Media / administration & dosage*
  • Contrast Media / adverse effects
  • Endoleak / diagnostic imaging
  • Endoleak / etiology
  • Endoleak / therapy
  • Endovascular Procedures* / adverse effects
  • Feasibility Studies
  • Humans
  • Male
  • Predictive Value of Tests
  • Radiography, Interventional / adverse effects
  • Radiography, Interventional / methods*
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / diagnosis
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Contrast Media
  • Carbon Dioxide