Carbon-dioxide Angiography in Patients with Mild-to-moderate Chronic Kidney Failure Undergoing Endovascular Repair of Abdominal Aortic Aneurysm

The aim of this study was to retrospectively compare the results of endovascular repair of abdominal aortic aneurysm (EVAR) with the use of angiography with carbon-dioxide (CO2) or with iodine-containing contrast agents (ICM) in patients with mild-to-moderate chronic kidney failure (CKD) in a single-center experience From July 2019 to December 2022, 230 EVARs were performed; data concerning these interventions were prospectively collected in an institutional database. A revision of such database was performed, and 42 patients with grade IIIa to IIIb CKD on the basis of the KDIGO Guidelines were found. In 21 cases, the intervention was performed using CO2 as contrast medium (CO2 group), whereas in the remaining 21, it was performed with the use of iodine-containing agents (ICM group). The values of serum creatinine and estimated glomerular filtration rate (GFR) were assessed preoperatively, in the second postoperative day, at the discharge, within the third postoperative month, and at the last disposable follow-up visit. The primary outcome of the study was the comparison of renal function over time in the two groups, whereas secondary endpoints included intraoperative data, technical success, mean hospital stay, and, during follow-up, graft-related complications, and reintervention and survival rates. There were no differences between the two groups in terms of baseline characteristics. The preoperative values of serum creatinine were 1.73 ± 0.36 mg/dL in the CO2 group and 1.6 ± 0.24 mg/dL in the ICM group (P = .09). A graft with suprarenal fixation was used in about 70% of patients in both groups. There were no differences in terms of duration of intervention, intraoperative detection of endoleaks, and unplanned intraoperative adjunctive procedures. Technical success was achieved in all the patients, and no perioperative death occurred. At discharge, a non-significant improvement of renal function with respect to preoperative values was found in both groups. The mean duration of follow-up was 14 months. There were no diffences between the two groups in terms of 2-year survival, graft-related complications, and reintervention rates. With regard to the primary endpoints, in the CO2 group, the serum creatinine values returned to preoperative values at 12 months, whereas in the ICM group, this value reached higher levels than preoperatively (Table I). A similar trend was observed in the analysis of eGFR values (Table II). The use of CO2 as contrast medium in patients with mild-to-moderate CKD undergoing EVAR was not associated in our experience with an impairment of renal function at 1 year, contrary to the findings among patients treated with ICM.Table IComparison between preoperative (pre) and follow-up (FU) values of serum creatinine in both groupsCreatinine preCreatinine FUPCO21.731.73.870ICM1.571.83.040CO2, Carbon dioxide; ICM, iodine-containing contrast agent. Open table in a new tab Table IIComparison between preoperative (pre) and follow-up (FU) values of estimated glomular filtration rate (eGFR) in both groupseGFR preeGFR FUPCO239.739.9.870ICM43.0437.86.040CO2, Carbon dioxide; ICM, iodine-containing contrast agent. Open table in a new tab