An Evaluation of the Use of Carbon Dioxide Angiography in Endovascular Aortic Aneurysm Repair

Abstract

Introduction: Renal dysfunction after endovascular aortic aneurysm repair is an increasingly recognised problem. Carbon dioxide (CO2) angiography has been used to limit the risk of contrast nephrotoxicity during endovascular procedures. This prospective study evaluates the performance of CO2 angiography during EVAR. Methods: Seventeen patients undergoing EVAR over a 12 month period were included. All were males with a median age of 74 (range 62-86) years. The median preoperative creatinine was 105 (range 77-165) µmol/L. CO2 angiography was used routinely in all patients for graft positioning. Contrast was used for completion angiograms and whenever CO2 did not satisfactorily demonstrate the anatomy. Results: All patients had successful deployment of stent graft. The median contrast usage was 59 (range 20-250)ml. CO 2 angiography successfully demonstrated the aortic and iliac bifurcation in all 17 cases and the renal artery anatomy in 9. 7 out of 17 patients had both CO2 and contrast completion angiography. CO2 correlated with contrast angiography in 6 of the 7 patients. There was no significant difference in pre and post-operative creatinine values (P >0.9; Wilcoxon test). Conclusion: CO2 angiography is a useful adjunct to contrast during the performance of EVAR and helps reduce contrast load and the risk of contrast nephrotoxicity.