Carbon dioxide contrast medium for endovascular treatment of ilio-femoral occlusive disease

Abstract

OBJECTIVES:Compare the use of carbon dioxide contrast medium with iodine contrast medium for the endovascular treatment of ilio-femoral occlusive disease in patients without contraindications to iodine.MATERIALS AND METHODS:From August 2012 to August 2014, 21 consecutive patients with ilio-femoral occlusive disease who were eligible for endovascular treatment and lacked contraindications to either iodine contrast or carbon dioxide were randomized into the carbon dioxide or iodine groups and subjected to ilio-femoral angioplasty.We analyzed the feasibility of the procedures, the surgical and clinical outcomes, the procedure lengths, the endovascular material costs, the contrast costs and the quality of the angiographic images in each group.RESULTS:No conversions to open surgery and no contrast media related complications were noted in either group. A post-operative femoral pulse was present in 88.9% of the iodine group and 80% of the carbon dioxide group. No differences in procedure length, endovascular material cost or renal function variation were noted between the groups. Four patients in the carbon dioxide group required iodine supplementation to complete the procedure. Contrast media expenses were reduced in the carbon dioxide group. Regarding angiographic image quality, 82% of the carbon dioxide images were graded as either good or fair by observers.CONCLUSIONS:The use of carbon dioxide contrast medium is a good option for ilio-femoral angioplasty in patients without contraindications to iodine and is not characterized by differences in endovascular material costs, procedure duration and surgical outcomes. In addition, carbon dioxide has lower contrast expenses compared with iodine.

Safety and Efficacy of Hybrid Angiography in Chronic Lower Extremity Ischemia Patients at Risk of Contrast-Induced Acute Kidney Injury

“…In the present study, using CO 2 alone or hybrid CO 2 -ICM angiography achieved satisfactory immediate surgical outcomes with a technical success rate of 95.6%, combined with a significant increase of postoperative ABI from .4 ± .1 to .8 ± .1. This technical success rate is comparable to those reported by Fujihara et al (97.9%), 9 Stegemann et al (96.9%), 16 and Mendes et al (91%) 11 with CO 2 -guided endovascular interventions to treat lower extremity arterial disease. Kaplan-Meier analysis yielded acceptable patency rates of 64.5%, 74.4%, and 87.3% for primary, assisted primary, and secondary patency rates, respectively, and AFS of 81% at one year.…”

“…9,10 CO 2 for vascular imaging, however, has been associated with multiple limitations including the poor image resolution, insufficient arterial filling, and the demanding technique. 11 This is especially true in CO 2 imaging of below the knee (BTK) arteries where the reduced image quality and fragmentation of the gas column can mimic arterial stenoses. [12][13][14][15] Knowing that decreasing amounts of used ICM is the most effective tool in preventing CI-AKI, 4 it seems prudent to adopt a hybrid angiography technique in risky patients for CI-AKI.…”

Contrast induced‐acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media: A meta‐analysis and systematic review of current literature

“…In the literature review, we found three RCTs that compared renal outcomes between CO 2 and ICM. Despite variable definitions for AKI, these studies appeared to favor the use of CO 2 with regards to renal injury . A small number of nonrandomized prospective and retrospective studies have also compared the two contrast agents.…”

Experiência inicial com ultrassom Doppler com contraste por microbolhas em adição ao ultrassom Doppler convencional para seguimento de correção endovascular de aneurisma de aorta abdominal

“…Para traçar uma comparação entre o CMUS e outros métodos de imagem disponíveis -angiografia com subtração digital (ASD), ATC, ARM e mesmo a arteriografia -, é importante considerar o potencial nocivo do contraste iodado e do gadolíneo 4,5,33 . O contraste iodado, usado tanto na ASD como na ATC, pode apresentar reações adversas imediatas, que ocorrem em 3,1% dos pacientes, quando utilizado contraste de baixa osmolaridade 4,5,34 .…”