Isaacson Ari J, Burke Lauren M B, Vallabhaneni Raghuveer, Farber Mark A
Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Ann Vasc Surg. 2016 Aug;35:234-7. doi: 10.1016/j.avsg.2016.01.045. Epub 2016 May 27.
Preoperative planning for fenestrated endovascular aortic repair (fEVAR) requires high-quality cross-sectional imaging, most commonly computed tomography angiography (CTA). However, in the setting of chronic kidney disease (CKD), the iodine load delivered during conventional CTA is associated with risk for acute kidney injury (AKI). In this report, we describe the feasibility of using transarterial catheter directed CT angiography (tcd-CTA) with ultralow-dose iodine as an alternative for fEVAR planning in patients with stage 3-4 CKD to lower the risk of AKI.
Preserum and postserum creatinine levels were retrospectively evaluated from 8 patients with stage 3-4 CKD who underwent tcd-CTA with 20 mL of Iohexol for fEVAR planning for the treatment of pararenal abdominal aortic aneurysms. The tcd-CTA images were evaluated by two vascular surgeons for adequacy for fEVAR planning and progression to fEVAR completion was recorded.
The mean serum creatinine before tcd-CTA was 2.1 ± .32 mg/dL, and the mean estimated glomerular filtration rate was 29.7 ± 6.31 mL/min/1.73 m(2). After tcd-CTA, the mean serum creatinine was 1.9 ± .25 mg/dL and the mean estimated glomerular filtration rate was 32.9 ± 5.12 mL/min/1.73 m(2). All 8 of the studies were determined to be adequate for fEVAR planning independently by two vascular surgeons. Six of the patients underwent successful fEVAR and 2 opted for watchful waiting.
tcd-CTA with ultralow-dose iodine is a feasible option for pre-fEVAR planning in patients with stage 3-4 CKD.
开窗式血管内主动脉修复术（fEVAR）的术前规划需要高质量的横断面成像，最常用的是计算机断层扫描血管造影（CTA）。然而，在慢性肾脏病（CKD）患者中，传统CTA检查时注入的碘负荷与急性肾损伤（AKI）风险相关。在本报告中，我们描述了使用经动脉导管导向CT血管造影（tcd-CTA）联合超低剂量碘作为3-4期CKD患者fEVAR术前规划的替代方案以降低AKI风险的可行性。
回顾性评估8例3-4期CKD患者的血清肌酐水平，这些患者接受了tcd-CTA检查，使用20ml碘海醇进行fEVAR术前规划，以治疗肾旁腹主动脉瘤。两名血管外科医生评估tcd-CTA图像是否适合fEVAR术前规划，并记录fEVAR完成情况。
tcd-CTA检查前血清肌酐平均水平为2.1±0.32mg/dL，平均估计肾小球滤过率为29.7±6.31ml/min/1.73m²。tcd-CTA检查后，血清肌酐平均水平为1.9±0.25mg/dL，平均估计肾小球滤过率为32.9±5.12ml/min/1.73m²。两名血管外科医生均独立判定所有8项研究的图像均适合fEVAR术前规划。6例患者成功接受了fEVAR手术，2例选择观察等待。
超低剂量碘的tcd-CTA是3-4期CKD患者fEVAR术前规划的可行选择。
