Criado Enrique, Kabbani Loay, Cho Kyung
Cardiovascular Center, Sections of Vascular Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
J Vasc Surg. 2008 Sep;48(3):527-34. doi: 10.1016/j.jvs.2008.04.061. Epub 2008 Jul 15.
Avoidance of nephrotoxic contrast agents during endovascular repair of abdominal aortic aneurysms (EVAR) may reduce the incidence of renal dysfunction following the procedure. Carbon dioxide (CO(2)) angiography is a safe alternative to iodinated contrast media vastly under-utilized by vascular surgeons. We herein describe our experience with a simple angiographic technique using CO(2) for EVAR guidance that does not require a separate angiographic catheter.
Eighteen patients underwent EVAR using angiography with CO(2) delivered through the endograft sheath. The renal and hypogastric arteries were localized for endograft deployment exclusively with CO(2) in all patients. Completion angiography was done with CO(2) in all patients and an additional angiogram with iodinated media was done in 13 cases.
All endograft deployments were done successfully with CO(2) angiography injected through the endograft delivery systems and femoral access sheaths. Additional iodinated media completion angiography did not modify the procedure in any case. All patients were discharged within two days after surgery. There were no ischemic or systemic complications related to CO(2) administration. Follow-up CT-scan revealed well positioned endografts with the expected patent renal and hypogastric arteries in all patients, and no additional endoleaks. No significant deterioration in renal function occurred in any case.
Carbon dioxide angiography conducted through the endograft delivery sheath is reliable for endograft deployment, safe, non-toxic and inexpensive. In addition, it may expedite EVAR by eliminating a number of angiographic catheter placements and exchanges during the procedure. This favorable experience warrants further utilization of this technique.
在腹主动脉瘤血管内修复术（EVAR）期间避免使用肾毒性造影剂，可能会降低术后肾功能障碍的发生率。二氧化碳（CO₂）血管造影是一种安全的替代方法，可替代碘化造影剂，但血管外科医生对此利用不足。我们在此描述我们使用CO₂进行EVAR引导的简单血管造影技术的经验，该技术无需单独的血管造影导管。
18例患者接受了通过移植物鞘管输送CO₂进行血管造影的EVAR。所有患者均仅使用CO₂定位肾动脉和下腹动脉以进行移植物植入。所有患者均使用CO₂进行了完成血管造影，13例患者还额外进行了一次碘化造影剂血管造影。
通过移植物输送系统和股动脉穿刺鞘管注入CO₂进行血管造影，所有移植物植入均成功完成。在任何情况下，额外的碘化造影剂完成血管造影均未改变手术过程。所有患者均在术后两天内出院。未发生与CO₂给药相关的缺血或全身并发症。随访CT扫描显示所有患者的移植物位置良好，肾动脉和下腹动脉通畅，且无额外的内漏。在任何情况下，肾功能均未出现明显恶化。
通过移植物输送鞘管进行的二氧化碳血管造影对于移植物植入是可靠的、安全的、无毒且廉价的。此外，它可以通过在手术过程中减少一些血管造影导管的放置和更换来加快EVAR的进程。这种良好的经验值得进一步应用该技术。
