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

Chiara De Angelis, Francesco Sardanelli, Matteo Perego, Marco Alì, Francesco Casilli, Luigi Inglese, Giovanni Mauri

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1655-1662
Number of pages8
JournalInternational Journal of Cardiovascular Imaging
Volume33
Issue number11
DOIs
Publication statusPublished - Nov 1 2017

Fingerprint

Abdominal Aortic Aneurysm
Chronic Renal Insufficiency
Carbon Dioxide
Angiography
Digital Subtraction Angiography
Endoleak
Viscera
Abdominal Pain
Prostheses and Implants
Aneurysm
Dilatation
Hand
Perfusion
Cholesterol
Kidney
Safety
Injections

Keywords

  • Abdominal aortic aneurysm (AAA)
  • Angiography
  • Carbon dioxide (CO)
  • Chronic kidney disease (CKD)
  • Endovascular aneurysm repair (EVAR)
  • Iodinated contrast material (ICM)

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Carbon dioxide (CO2) angiography as an option for endovascular abdominal aortic aneurysm repair (EVAR) in patients with chronic kidney disease (CKD). / De Angelis, Chiara; Sardanelli, Francesco; Perego, Matteo; Alì, Marco; Casilli, Francesco; Inglese, Luigi; Mauri, Giovanni.

In: International Journal of Cardiovascular Imaging, Vol. 33, No. 11, 01.11.2017, p. 1655-1662.

Research output: Contribution to journalArticle

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abstract = "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.",
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AU - De Angelis, Chiara

AU - Sardanelli, Francesco

AU - Perego, Matteo

AU - Alì, Marco

AU - Casilli, Francesco

AU - Inglese, Luigi

AU - Mauri, Giovanni

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