Carbon dioxide digital subtraction angiography–assisted endovascular aortic aneurysm repair in the azotemic patient

Chao, Alex; Major, Kevin; Kumar, S. Ram; Patel, Kevin; Trujillo, Israel Alfonso; Hood, Douglas B.; Rowe, Vincent L.; Weaver, Fred A.

doi:10.1016/j.jvs.2006.11.017

Cited by 94 publications

(75 citation statements)

References 25 publications

(26 reference statements)

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“…7,14-18 Also, a few studies have shown the accuracy of CO 2 -DSA in detecting ELs. 16,17,19 Huang et al reported that the sensitivity to detect any EL and both the sensitivity and specificity to detect type I ELs with CO 2 -DSA are acceptable. 7 However, for detection of type II ELs with CO 2 -DSA, the sensitivity and PPV are poor.…”

Section: Discussionmentioning

confidence: 99%

Carbon dioxide digital subtraction angiography as an option for detection of endoleaks in endovascular abdominal aortic aneurysm repair procedure

Sueyoshi

Nagayama

Sakamoto

et al. 2015

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Carbon dioxide digital subtraction angiography as an option for detection of endoleaks in endovascular abdominal aortic aneurysm repair procedure

Sueyoshi

Nagayama

Sakamoto

et al. 2015

Journal of Vascular Surgery

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“…Therefore, placement of a guiding sheath could eliminate these problems. Carbon dioxide has been used to avoid adverse effects of ICM in diagnostic and EVAR procedures (5,14). However, since the use of carbon dioxide requires experience and special instruments, it is not widely used in our country, which is similar to the rest of the world.…”

Section: Discussionmentioning

confidence: 99%

“…To avoid the adverse effect of contrast media, carbon dioxide angiography and intravascular ultrasonography (IVUS) have been assessed as an alternative strategy in EVAR (5,6). Intravenous hydration with saline, low-, or iso-osmolar nonionic contrast media as well as lower doses of contrast media can minimize CIN (4).…”

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confidence: 99%

Reduction of iodinated contrast load with the renal artery catheterization technique during endovascular aortic repair

Canyiğit

Çetín²,

Uğuz³

et al. 2012

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to present our clinical experience with the renal artery catheterization (RAC) technique, which reduces the volume of intra-arterial contrast media (ICM) used during endovascular aortic repair (EVAR), and describe the short-term results of this technique. MATERIALS AND METHODSWe retrospectively evaluated 16 patients (15 males and one female) who underwent EVAR between March 2011 and February 2012 using the RAC technique for an abdominal aortic aneurysm. A Simmons-1 catheter was preferred for renal artery cannulation. The mean age of the patients at the time of treatment was 70 years (range, 61-82 years). Fifteen cases were fusiform aneurysms, and one case was a saccular aneurysm. Creatinine and estimated glomerular filtration rate (eGFR) values were recorded before the procedure and during the first 72 hours postprocedure. RESULTSBifurcated stent grafts were implanted with 100% procedural success using the RAC technique. The inferiorly positioned renal artery was cannulated with a Simmons-1 catheter in the first five patients, and was maintained at the level of the renal artery orifice in the remaining patients. The mean volume of the ICM used was 47 mL (range, 23-83 mL). The creatinine and eGFR values were not significantly different between the pre-and postoperative periods (P > 0.05). CONCLUSIONReducing the volume of ICM used during EVAR is critical for protecting renal function. The RAC technique is a safe and effective method in appropriate patients when performed by experienced clinicians.A lthough contrast medium induced nephropathy (CIN) is a rare occurrence in patients with serum creatinine levels less than 132 µmol/L (1.5 mg/dL) or a preferred estimated glomerular filtration rate (eGFR) greater than 60 mL/min/1.73 m 2 with an incidence less than 2%, it is more prominent in patients with diabetic nephropathy (19.7%) and pre-existing renal impairment (3%-33%) (1). Patients who undergo endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA) are often elderly, and diabetes mellitus and/or renal impairment are common in this group of patients (2, 3). Dehydration, congestive heart failure, multiple myeloma, and concurrent use of nephrotoxic drugs as well as larger doses of contrast media and multiple injections within 72 hours are also risk factors for CIN (1, 4). In addition, intra-arterial contrast media (ICM), especially when given into the renal arteries or the aorta at the origins of the renal artery, as in EVAR, is more nephrotoxic than intravenous administration (1, 4). Furthermore, pre-and postoperative computed tomography (CT) angiographies as well as EVAR can also cumulatively increase the risk of CIN.Although strategies used for solving contrast related problems have improved over the years as a result of the development of contrast agents, contrast-related morbidity is still a serious issue. To avoid the adverse effect of contrast media, carbon dioxide angiography and intravascular ultrasonography (IVUS) have been assessed as an alternative strate...

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“…Carbon dioxide digital subtraction angiography is a good alternative for endovascular repair of aortic aneurysms in azotemic patients. 8 Approximately 80% less contrast medium is utilized with endovascular aortic aneurysm repair. 8 If the image quality of carbon dioxide digital subtraction angiography is equivalent to that of conventional subtraction angiography for visualizing endoleaks at the end of the procedure, it can exclude contrast medium usage completely and is more advantageous than intravascular US.…”

Section: Discussionmentioning

confidence: 99%

Endovascular stent-graft repair for abdominal aortic aneurysm in a patient with cardiac and renal dysfunction

Handa

Tomita

Kato

et al. 2009

Gen Thorac Cardiovasc Surg

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This case report details our experience with endovascular stent-graft repair for an abdominal aortic aneurysm (AAA) in a patient who was previously treated by left ventricular remodeling for dilated cardiomyopathy. Renal dysfunction with an elevated creatinine level (1.59 mg/dl) was managed by reducing the dose of contrast medium utilizing intravascular ultrasonography. Using a Zenith AAA endovascular device, the aneurysmal sac was successfully excluded and was thrombosed. Endovascular stenting is a good treatment option for abdominal aneurysm repair in patients with poor heart function and renal impairment.

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Carbon dioxide digital subtraction angiography–assisted endovascular aortic aneurysm repair in the azotemic patient

Cited by 94 publications

References 25 publications

Carbon dioxide digital subtraction angiography as an option for detection of endoleaks in endovascular abdominal aortic aneurysm repair procedure

Carbon dioxide digital subtraction angiography as an option for detection of endoleaks in endovascular abdominal aortic aneurysm repair procedure

Reduction of iodinated contrast load with the renal artery catheterization technique during endovascular aortic repair

Endovascular stent-graft repair for abdominal aortic aneurysm in a patient with cardiac and renal dysfunction

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