Unit of Vascular Surgery, Department of General Surgery, Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt.
Department of Vascular Surgery, AL-Sheikh Zayed Specialized Hospital, Ministry of Health and Population, Sheikh Zayed City, Egypt.
J Endovasc Ther. 2024 Oct;31(5):772-783. doi: 10.1177/15266028231159241. Epub 2023 Mar 16.
To assess the safety and effectiveness of using carbon dioxide (CO) contrast in both supra- and infra-genicular endovascular interventions in patients with renal impairment.
This is a multicentric prospective observational study conducted over a period of 3 years from 2017 to 2020; the study included 114 patients presented with chronic threatening limb ischemia (CTLI) and renal impairment (lowest serum creatinine levels ≥1.3 mg/dL) for whom endovascular procedures were done using CO as a contrast medium. Endovascular angiography was guided by CO either exclusively (zero contrast) or with the aid of small amount of supplementary iodinated contrast media (ICM) injections. The qualitative assessment of the angiographic images in both supra- and infra-genicular fields were reported and scaled.
The qualitative diagnostic images were excellent in 86.5% in the supra-genicular and 66.5% in infra-genicular images. There were no significant changes in mean serum creatinine levels from baseline to first and fifth days post procedural (mean 1.8 mg/dL vs mean 1.9 mg/dL and mean 1.7 mg/dL).
CO is a non-nephrotoxic alternative to traditional ICM that could be safely used and well tolerated during endovascular interventions for peripheral arterial disease in patients with renal impairment. Primary safety and efficacy endpoints were achieved in 100% of cases. The use of automated injector system provides adequate delivery, optimizes the dose, and avoids air contamination. For infra-genicular segment opacification, we recommend super-selective injections and some changes in angiographic techniques from contrast preparation to image post-processing.
Co is a non-nephrotoxic alternative to traditional ICM that could be safely used and well tolerated during peripheral endovascular interventions in patients with renal impairment. The use of automated injector system would provide adequate delivery, optimizes the dose and avoids air contamination. For infra-genicular segment opacification, its recommended to use selective injection as close to the target artery as possible and some changes in angiographic techniques from contrast preparation to image post-processing.
评估在肾功能损害患者的腘上和腘下腔内血管介入中使用二氧化碳（CO）对比剂的安全性和有效性。
这是一项多中心前瞻性观察研究，于 2017 年至 2020 年期间进行，共纳入 114 例患有慢性威胁肢体缺血（CTLI）和肾功能损害（最低血清肌酐水平≥1.3mg/dL）的患者，这些患者接受了 CO 作为对比剂的腔内手术。腔内血管造影术通过 CO 进行引导，要么完全（零对比），要么在少量补充碘对比剂（ICM）注射的帮助下进行。报告和评估了腘上和腘下两个领域的血管造影图像的定性评估。
在腘上图像中，定性诊断图像的优秀率为 86.5%，在腘下图像中为 66.5%。从基线到术后第 1 天和第 5 天，平均血清肌酐水平没有显著变化（平均 1.8mg/dL 与平均 1.9mg/dL 和平均 1.7mg/dL）。
CO 是一种对传统 ICM 无毒的替代品，可在肾功能损害患者的外周动脉疾病的腔内介入治疗中安全使用并耐受良好。100%的病例达到了主要的安全性和疗效终点。使用自动注射器系统可提供足够的输送量，优化剂量，并避免空气污染。对于腘下段的显影，我们建议采用超选择性注射，并在造影剂准备到图像后处理过程中改变一些血管造影技术。
CO 是一种对传统 ICM 无毒的替代品，可在肾功能损害患者的外周血管腔内介入治疗中安全使用并耐受良好。使用自动注射器系统可提供足够的输送量，优化剂量，并避免空气污染。对于腘下段的显影，建议尽可能靠近靶动脉进行选择性注射，并在造影剂准备到图像后处理过程中改变一些血管造影技术。
