Spath Paolo, Caputo Stefania, Campana Federica, Gallitto Enrico, Pini Rodolfo, Mascoli Chiara, Vacirca Andrea, Faggioli Gianluca, Gargiulo Mauro
Vascular Surgery, University of Bologna, DIMEC, 40138 Bologna, Italy.
Vascular Surgery Unit, Hospital «Infermi», AUSL Romagna, 47923 Rimini, Italy.
J Clin Med. 2024 Aug 7;13(16):4634. doi: 10.3390/jcm13164634.
: Carbon dioxide digital-subtraction angiography (CO-DSA) is an increasingly adopted technique in endovascular aortic repair (EVAR) and fenestrated/branched EVAR (F/B-EVAR); it is used to reduce the amount of iodinate contrast medium (ICM) and prevent postoperative renal function worsening (PO-RFW). Our aim is to report results from the literature on EVAR and F/B-EVAR procedures using CO-DSA, together with wider applications in aortic endovascular treatment. : We performed a literature review by searching electronic databases for published data on CO-DSA during EVAR and F/B-EVAR procedures. The endpoints were postoperative renal function worsening (PO-RFW) and efficacy of intraoperative arterial visualization. Further, applications of CO for thoracic endovascular aortic repair (TEVAR) were described. : Seventeen studies reporting results on CO-DSA in EVAR (644 patients) were retrieved. Overall, 372 (58%) procedures were performed with CO alone, and 272 (42%) were performed with CO+ICM. Eight studies analyzed the effect of CO-DSA angiography on PO-RFW; four studies showed a significantly lower rate of PO-RFW compared to ICM. Five studies (153 patients) analyzed intraoperative arterial visualization with CO-DSA; renal and hypogastric arteries were effectively visualized in 69% and 99% of cases, respectively. The use of CO-DSA in F/B-EVAR has not been widely investigated. The largest series reported that PO-RFW was lower in the CO vs. ICM group. : Carbon dioxide is widely applied in modern aortic endovascular treatment. CO-DSA for EVAR and F/B-EVAR is an efficient technique for reducing PO-RFW while allowing acceptable arterial intraoperative visualization.
二氧化碳数字减影血管造影（CO-DSA）是一种在血管腔内主动脉修复术（EVAR）和开窗/分支型EVAR（F/B-EVAR）中越来越常用的技术；它用于减少碘造影剂（ICM）的用量，并预防术后肾功能恶化（PO-RFW）。我们的目的是报告使用CO-DSA进行EVAR和F/B-EVAR手术的文献结果，以及其在主动脉血管腔内治疗中的更广泛应用。：我们通过搜索电子数据库对EVAR和F/B-EVAR手术期间有关CO-DSA的已发表数据进行了文献综述。终点指标为术后肾功能恶化（PO-RFW）和术中动脉显影效果。此外，还描述了CO在胸主动脉腔内修复术（TEVAR）中的应用。：检索到17项报告EVAR中CO-DSA结果的研究（644例患者）。总体而言，372例（58%）手术仅使用CO进行，272例（42%）手术使用CO+ICM进行。八项研究分析了CO-DSA血管造影对PO-RFW的影响；四项研究表明，与ICM相比，PO-RFW的发生率显著降低。五项研究（153例患者）分析了使用CO-DSA进行术中动脉显影的情况；肾动脉和下腹动脉的有效显影率分别为69%和99%。CO-DSA在F/B-EVAR中的应用尚未得到广泛研究。最大的系列报道显示，CO组的PO-RFW低于ICM组。：二氧化碳在现代主动脉血管腔内治疗中得到广泛应用。用于EVAR和F/B-EVAR的CO-DSA是一种有效的技术，可减少PO-RFW，同时使术中动脉显影效果可接受。
