Zero-Contrast EVAR Can Be Reached Using Automated Carbon Dioxide Digital Angiography, Endoaortic Balloon Occlusion, and IVUS.

Autores de IIS La Fe

• Manuel Miralles Hernández

  Autor

• Luis Javier García Domínguez

  Autor

• Noelia Garzon Bergada

  Autor

• Eliseo Candela Beltrán

  Autor

• Emma Plana Andani

  Autor

Participantes ajenos a IIS La Fe

• Mursia FM
• Bellmunt S

Grupos

• Hemostasia, Trombosis, Arteriosclerosis y Biología vascular

Abstract

OBJECTIVE: To introduce a new method to enhance the visualization of renal arteries and the accuracy of graft deployment during CO(2)-assisted endovascular (EV) aneurysm repair (EVAR). METHODS: A retrospective observational study of consecutive EVAR cases assisted with CO(2) angiography (CO(2)Angio) was conducted. This nonrandomized design reflects real-life progressive attempts to enhance the reliability of CO(2) and intravascular ultrasound (IVUS), minimizing the use of iodinated contrast (IC) and radiation, respectively. Cases were divided into 3 groups according to consecutive periods: CO(2)Angio (n = 7), CO(2)Angio and balloon occlusion of the infrarenal aorta (CO(2)Angio + EVclamp, n = 11), and CO(2)Angio + EVclamp + IVUS (n = 18). IC was permitted in case of insufficient visualization with CO(2)Angio during any phase of the procedure. Demographic, clinical, and procedure variables (volume of IC and CO(2), radiation, fluoroscopy time, leaks) were collected from electronic clinic histories and statistically analyzed. RESULTS: A significant decrease was found in the third group, after introducing both techniques, for total radiation (air kerma; 3,039 ± 2,792.3 vs 3,434.7 ± 1,289.2 vs 2,284.6 ± 841.5 mGy, P = 0.041), radiation per area, dose area product (47 ± 34.7 vs 54.5 ± 15.3 vs 41.3 ± 12.8 mGy×m(2), P = 0.03), and IC volume (104.3 ± 102.4 vs 89.2 ± 53.9 vs 15.4 ± 27.4 mL, P < 0.001), arriving at the goal of "zero contrast" in the last 12 patients. No significant differences were detected in fluoroscopy time, total operative time, total CO(2) volume, or change in renal function. CONCLUSIONS: The introduction of endoluminal occlusion with a balloon and the use of IVUS in CO(2)-assisted EVAR enabled us to achieve the objective of zero contrast and a progressive decrease in radiation dose.

Keywords

• CO2 angiography; EVAR; IVUS; aorta; aortic balloon