Stegemann Emilia, Tegtmeier Catharina, Bimpong-Buta Nana Yaw, Sansone Roberto, Uhlenbruch Mark, Richter Andreas, Stegemann Berthold, Roden Michael, Westenfeld Ralf, Kelm Malte, Heiss Christian
Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany.
Department of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany.
Angiology. 2016 Oct;67(9):875-81. doi: 10.1177/0003319715614701. Epub 2015 Nov 3.
Chronic kidney disease is a common comorbidity in patients with peripheral artery disease. We investigated the safety and efficacy of carbon dioxide (CO2) as supplemental contrast agent to decrease contrast volume during fluoroscopy-guided peripheral vascular procedures in routine angiological practice. We analyzed 191 consecutive interventions of the lower extremity in claudicants and critical limb ischemia (CLI) that were performed with iodinated contrast media (ICM) alone (n = 154) or with the aided or exclusive use of CO2 (n = 37). The technical success rate, total irradiation, and intervention time were not significantly different between ICM and CO2 No severe procedure-related complications occurred. The contrast volume was lower in CO2 than in ICM. Although kidney function, creatinine, and estimated glomerular filtration rate was lower in CO2 at baseline, the incidence of contrast-induced nephropathy was lower in CO2 compared to ICM. These data support CO2 as an alternative supplemental contrast agent that can be applied safely and efficiently to lower contrast volume during peripheral vascular interventions preventing kidney dysfunction even in patients with disease of the popliteal artery and below the knee and CLI.
慢性肾脏病是外周动脉疾病患者常见的合并症。我们研究了在常规血管造影实践中，二氧化碳（CO₂）作为补充造影剂在荧光透视引导下的外周血管手术中减少造影剂用量的安全性和有效性。我们分析了191例连续进行的下肢介入手术，这些手术的患者为间歇性跛行和严重肢体缺血（CLI）患者，其中仅使用碘化造影剂（ICM）进行手术的有154例，辅助或单独使用CO₂进行手术的有37例。ICM组和CO₂组的技术成功率、总照射时间和介入时间无显著差异。未发生严重的与手术相关的并发症。CO₂组的造影剂用量低于ICM组。尽管基线时CO₂组的肾功能、肌酐和估算肾小球滤过率较低，但与ICM组相比，CO₂组造影剂肾病的发生率较低。这些数据支持将CO₂作为一种替代补充造影剂，其可安全有效地应用于外周血管介入手术中，以减少造影剂用量，即使在腘动脉及膝以下疾病和CLI患者中也能预防肾功能障碍。
