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

Abstract

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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