Carbon dioxide digital subtraction angiography–assisted endovascular aortic aneurysm repair in the azotemic patient
Presented at the Twenty-First Annual Meeting of the Western Vascular Society, La Jolla, Calif, Sept 16-19, 2006.
Received 18 September 2005; accepted 3 November 2006. published online 26 January 2007.
Objective
This report analyzes the safety and efficacy of carbon dioxide digital subtraction angiography (CO2-DSA) for EVAR in a group of patients with renal insufficiency compared with a concurrent group of patients with normal renal function undergoing EVAR with iodinated contrast angiography (ICA).
Methods
Between 2003 and 2005, 100 consecutive patients who underwent EVAR using ICA, CO2-DSA, or both were retrospectively reviewed, and preoperative, intraoperative, postoperative, and follow-up variables were collected. Patients were divided into two groups depending on renal function and contrast used. Group I comprised patients with normal renal function in whom ICA was used exclusively, and group II patients had a serum creatinine ≥1.5 mg/dL, and CO2-DSA was used preferentially and supplemented with ICA, when necessary. The two groups were compared for the outcomes of successful graft placement, renal function, endoleak type, and frequency, and the need for graft revision. Comparisons were made using χ2 analysis, Student t test, and the Fisher exact test.
Results
A total of 84 EVARs were performed in group I and 16 in group II. Patient demographics and risk factors were similar between groups with the exception of serum creatinine, which was significantly increased in group II (1.8 mg/dL vs 1.0 mg/dL P < .0005). All 100 endografts were successfully implanted. Patients in group II had longer fluoroscopy times, longer operative times, and increased radiation exposure, and 13 of 16 patients required supplemental ICA. Mean iodinated contrast use was 27 mL for group II vs 148 mL in group I (P < .0005). Mean postoperative serum creatinine was unchanged from baseline, and 30-day morbidity was similar for both groups. No patient required dialysis. No patients died. Perioperatively, and at 1 and 6 months, the endoleak type and incidence and need for endograft revision was no different between groups.
Conclusions
CO2-DSA is safe, can be used to guide EVAR, and provides outcomes similar to ICA-guided EVAR. CO2-DSA protects renal function in the azotemic patient by lessening the need for iodinated contrast and associated nephrotoxicity, but with the tradeoff of longer fluoroscopy and operating room times and increased radiation exposure.
Department Surgery, Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
Correspondence: Fred A Weaver, MD, MMM, Professor and Chief, Vascular Surgery and Endovascular Therapy, 1510 San Pablo St, Suite 514, Los Angeles, CA 90033.
ABSTRACT