Uyanik Sadık Ahmet, Birgi Erdem, Öztürk Saffet, Asfuroğlu Umut, Tangobay Erdi, Güven Hikmet Erhan
Department of Radiology, Etlik City Hospital, Ankara, Turkiye.
Department of Radiology, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkiye.
Turk J Med Sci. 2025 May 30;55(4):877-886. doi: 10.55730/1300-0144.6040. eCollection 2025.
BACKGROUND/AIM: This study investigates the role of carbon dioxide (CO) angiography, delivered with an automated CO delivery system, in decreasing the amount of iodinated contrast and preventing contrast-induced nephropathy (CIN) in diabetic foot patients who underwent endovascular revascularization.
A total of 272 diabetic foot patients who underwent endovascular treatment for infrainguinal chronic peripheral arterial disease (PAD) were included in the study. Of these, 64 patients underwent endovascular intervention using CO angiography (study group), while 208 patients underwent endovascular intervention using only contrast media (control group). The rates of CIN and the amount of contrast used during interventions were recorded alongside secondary outcomes, including technical success, complication rates, and complications related to CO usage.
The mean contrast volume used in the CO group was significantly lower than in the control group (24.3 ± 13.3 cc vs 89.4 ± 24.8 cc; p < 0.001). CIN was detected in 41 patients. The incidence of CIN was 17.7% in the control group, while it was significantly lower in the CO group at 6.2% (p = 0.024). In a subgroup of patients with chronic kidney disease stage 3-5, CIN incidence remained significantly lower in the CO group (6.2% vs 38.2%, p < 0.001), and multivariate analysis identified CO use as an independent protective factor (OR: 0.027, 95% CI: 0.005-0.133, p < 0.001). Technical success rates were comparable between the groups (93.7% vs 93.2%; p = 0.892). Pain after CO injection was recorded in 11 patients, and no other adverse effect due to CO usage was observed. There were no major complications, and only minor complications occurred (8%).
CO angiography may play a crucial role in minimizing the risk of CIN in this specific population, who are more vulnerable to this complication and its associated morbidity and mortality. Further multicenter prospective studies are needed to better define the role of CO angiography in high-risk patients.
背景/目的：本研究探讨采用自动二氧化碳（CO）输送系统进行的CO血管造影在减少糖尿病足患者血管内血运重建术中碘造影剂用量及预防造影剂肾病（CIN）方面的作用。
本研究纳入了272例因下肢慢性外周动脉疾病（PAD）接受血管内治疗的糖尿病足患者。其中，64例患者采用CO血管造影进行血管内介入治疗（研究组），而208例患者仅使用造影剂进行血管内介入治疗（对照组）。记录CIN发生率及介入治疗期间使用的造影剂用量，同时记录次要结局，包括技术成功率、并发症发生率以及与使用CO相关的并发症。
CO组使用的造影剂平均体积显著低于对照组（24.3±13.3毫升对89.4±24.8毫升；p<0.001）。41例患者检测出CIN。对照组CIN发生率为17.7%，而CO组显著更低，为6.2%（p = 0.024）。在慢性肾脏病3 - 5期患者亚组中，CO组CIN发生率仍显著更低（6.2%对38.2%，p<0.001），多因素分析确定使用CO为独立保护因素（比值比：0.027，95%置信区间：0.005 - 0.133，p<0.001）。两组技术成功率相当（93.7%对93.2%；p = 0.892）。11例患者记录到注射CO后疼痛，未观察到因使用CO导致的其他不良反应。无重大并发症，仅发生轻微并发症（8%）。
CO血管造影在使这一特别易患该并发症及其相关发病率和死亡率的人群中CIN风险降至最低方面可能起关键作用。需要进一步开展多中心前瞻性研究以更好地明确CO血管造影在高危患者中的作用。
