Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT.
Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT.
J Vasc Surg. 2023 Jul;78(1):201-208. doi: 10.1016/j.jvs.2023.03.029. Epub 2023 Mar 21.
Patients with chronic kidney disease (CKD) who undergo peripheral vascular interventions (PVI) with iodinated contrast are at higher risk of post-contrast acute kidney injury (PC-AKI). Carbon dioxide (CO) angiography can reduce iodinated contrast volume usage in this patient population, but its impact on PC-AKI has not been studied. We hypothesize that CO angiography is associated with a decrease in PC-AKI in patients with advanced CKD.
The Vascular Quality Initiative PVI dataset from 2010 to 2021 was reviewed. Only patients with advanced CKD (estimated glomular filtration rate <45 ml/min/1.73 m) treated for peripheral arterial disease were included. Propensity matching and multivariate logistic regression based on demographics, comorbidities, CKD stage, and indications were used to compare the outcomes of patients treated with and without CO.
There were 20,706 PVIs performed in patients with advanced CKD, and only 22% utilized CO angiography. Compared with patients treated without CO, patients who underwent CO angiography were younger and less likely to be women or White, and more likely to have poor renal function, diabetes, cardiac comorbidities, and present with tissue loss. Propensity matching yielded well-matched groups with 4472 patients in each group. The procedural details after matching demonstrated 50% reduction in the volume of contrast used (32±33 vs 65±48 mL; P < .01). PVI with CO angiography was associated with lower rates of PC-AKI (3.9% vs 4.8%; P = .03) and cardiac complications (2.1% vs 2.9%; P = .03) without a significant difference in technical failure or major/minor amputations. Low contrast volumes (≤50 mL for CKD3, ≤20 mL for CKD4, and ≤9 mL for CKD5) are associated with reduced risk of PC-AKI (hazard ratio, 0.59; P < .01).
CO angiography reduces iodinated contrast volume usage during PVI and is associated with decreased cardiac complications and PC-AKI. CO angiography is underutilized and should be considered for patients with advanced CKD who require endovascular therapy.
患有慢性肾脏病（CKD）并接受外周血管介入（PVI）治疗的患者使用碘造影剂后发生造影剂相关急性肾损伤（PC-AKI）的风险更高。二氧化碳（CO）血管造影术可减少此类患者的碘造影剂用量，但尚未研究其对 PC-AKI 的影响。我们假设 CO 血管造影术与 CKD 晚期患者的 PC-AKI 发生率降低有关。
回顾了 2010 年至 2021 年期间血管质量倡议（Vascular Quality Initiative，VQI）的 PVI 数据集。仅纳入患有晚期 CKD（估计肾小球滤过率<45ml/min/1.73m）且接受外周动脉疾病治疗的患者。基于人口统计学、合并症、CKD 分期和适应证，采用倾向匹配和多变量逻辑回归分析比较了接受和未接受 CO 治疗的患者的结局。
在患有 CKD 的 20706 例 PVI 中，仅 22%的患者使用了 CO 血管造影术。与未接受 CO 治疗的患者相比，接受 CO 治疗的患者年龄较小，女性和白人的比例较低，肾功能较差、合并糖尿病、心脏合并症的患者更多，且存在组织缺失。倾向匹配后，每组均有 4472 例患者，匹配后手术细节显示造影剂用量减少 50%（32±33 vs 65±48ml；P<0.01）。CO 血管造影术与较低的 PC-AKI 发生率（3.9% vs 4.8%；P=0.03）和心脏并发症发生率（2.1% vs 2.9%；P=0.03）相关，而技术失败或主要/次要截肢的发生率无显著差异。低造影剂用量（CKD3 组≤50ml，CKD4 组≤20ml，CKD5 组≤9ml）与 PC-AKI 风险降低相关（风险比，0.59；P<0.01）。
CO 血管造影术可减少 PVI 过程中的碘造影剂用量，与心脏并发症和 PC-AKI 发生率降低相关。CO 血管造影术的使用率较低，对于需要血管内治疗的 CKD 晚期患者应考虑使用。
