Diamantopoulos Athanasios, Patrone Lorenzo, Santonocito Serafino, Theodoulou Iakovos, Ilyas Shazhad, Dourado Renato, Game David, Karunanithy Narayan, Patel Sanjay, Zayed Hany, Katsanos Konstantinos
Department of Interventional Radiology, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, London, SE1 7EH, UK.
Kings College London, School of Medicine, London, UK.
CVIR Endovasc. 2020 Feb 17;3(1):9. doi: 10.1186/s42155-020-0103-z.
Iodinated contrast media are amongst the most frequently prescribed medications, however, their use is not without complications. With contrast-induced nephropathy constituting a major concern, alternative non-iodine based approaches have been explored such as carbon dioxide angiography. The purpose of this study is to report the incidence of contrast-induced nephropathy following carbon dioxide angiography in patients with impaired renal function that underwent peripheral angioplasty compared with a historical cohort of patients that underwent angioplasty with use of solely iodine contrast medium. The historical cohort of patients treated with iodinated contrast was used as control. Baseline demographics and renal function tests were recorded. Primary outcome was incidence of contrast-induced nephropathy within 48-72 h post intervention. Receiver-Operating-Characteristic curve analysis was used to correlate the volume of iodinated contrast with the risk of contrast-induced nephropathy.
Carbon Dioxide was used as an alternative to iodinated contrast media in patients with impaired renal function (eGFR<60mls/min/1.73 m2) undergoing peripheral angioplasty procedures. Fifty, consecutive patients (baseline eGFR = 38.6 ± 13.2mls/min/1.73 m2) were included in a prospective clinical audit. These were matched (1:2) with a historical cohort of patients (baseline eGFR = 43.3 ± 12.2mls/min/1.73 m2) treated with Iodinated contrast media. The incidence of contrast-induced nephropathy was 14% (n = 7/50) in case of carbon dioxide vs. 29% (n = 29/100) in the matched cohort group (p = 0.045). Receiver-Operating-Characteristic analysis showed that use of >25mls of contrast was 94.4% (95% CI:81-99%) sensitive in predicting contrast-induced nephropathy.
Carbon dioxide imaging during peripheral angioplasty procedures protects against contrast-induced nephropathy. Use of >25mls of iodinated contrast media in high-risk patients is a predictor of contrast-induced nephropathy.
碘化造影剂是最常开具的药物之一，然而，其使用并非没有并发症。鉴于造影剂肾病是一个主要问题，人们探索了替代的非碘基方法，如二氧化碳血管造影。本研究的目的是报告与仅使用碘造影剂进行血管成形术的历史队列患者相比，接受外周血管成形术的肾功能受损患者在二氧化碳血管造影后造影剂肾病的发生率。使用碘化造影剂治疗的历史队列患者作为对照。记录基线人口统计学和肾功能测试结果。主要结局是干预后48 - 72小时内造影剂肾病的发生率。采用受试者操作特征曲线分析来关联碘化造影剂的用量与造影剂肾病的风险。
在接受外周血管成形术的肾功能受损（估算肾小球滤过率<60ml/min/1.73m²）患者中，使用二氧化碳替代碘化造影剂。50例连续患者（基线估算肾小球滤过率 = 38.6 ± 13.2ml/min/1.73m²）被纳入前瞻性临床审计。这些患者与使用碘化造影剂治疗的历史队列患者（基线估算肾小球滤过率 = 43.3 ± 12.2ml/min/1.73m²）进行匹配（1:2）。二氧化碳组造影剂肾病的发生率为14%（n = 7/50），而匹配队列组为29%（n = 29/100）（p = 0.045）。受试者操作特征分析表明，使用>25ml造影剂预测造影剂肾病的敏感性为94.4%（95%置信区间：81 - 99%）。
外周血管成形术期间的二氧化碳成像可预防造影剂肾病。高危患者使用>25ml碘化造影剂是造影剂肾病的一个预测指标。
