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

C. De Angelis, F. Sardanelli, M. Perego, M. Alì, F. Casilli, L. Inglese, G. Mauri

Research output: Contribution to journalArticlepeer-review


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. © 2017, European Union.
Original languageEnglish
Pages (from-to)1655-1662
Number of pages8
JournalInternational Journal of Cardiovascular Imaging
Issue number11
Publication statusPublished - 2017


  • Abdominal aortic aneurysm (AAA)
  • Angiography
  • Carbon dioxide (CO2)
  • Chronic kidney disease (CKD)
  • Endovascular aneurysm repair (EVAR)
  • Iodinated contrast material (ICM)
  • carbon dioxide
  • contrast medium
  • abdominal aortic aneurysm
  • abdominal pain
  • aged
  • Article
  • cholesterol embolism
  • chronic kidney failure
  • clinical article
  • cohort analysis
  • conservative treatment
  • controlled study
  • digital subtraction angiography
  • endoleak
  • endovascular aneurysm repair
  • feasibility study
  • human
  • image analysis
  • image quality
  • male
  • patient safety
  • retrospective study
  • blood vessel transplantation
  • complication
  • diagnostic imaging
  • endovascular surgery
  • interventional radiology
  • predictive value
  • procedures
  • treatment outcome
  • very elderly
  • Aged
  • Aged, 80 and over
  • Angiography, Digital Subtraction
  • Aortic Aneurysm, Abdominal
  • Blood Vessel Prosthesis Implantation
  • Carbon Dioxide
  • Contrast Media
  • Endoleak
  • Endovascular Procedures
  • Feasibility Studies
  • Humans
  • Male
  • Predictive Value of Tests
  • Radiography, Interventional
  • Renal Insufficiency, Chronic
  • Retrospective Studies
  • Treatment Outcome


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