Targeted renal therapy and contrast-induced nephropathy during endovascular abdominal aortic aneurysm repair: results of a feasibility pilot trial.
OBJECTIVE
To evaluate the feasibility of targeted renal therapy (TRT) to decrease the rate of contrast-induced nephropathy (CIN) during endovascular aortic aneurysm repair (EVAR) in patients at risk for CIN.


METHODS
A prospective nonrandomized analysis of TRT was performed in 10 high-risk patients (8 men; median age 66.5 years, range 56-80) with pre-existing renal insufficiency. TRT involved high-dose intrarenal artery infusions of fenoldopam (FEN), a short acting selective dopamine-1 agonist and renal arteriolar vasodilator, delivered percutaneously via a left brachial access using the 5-F Benephit PV Infusion System during EVAR.


RESULTS
There were no device-related complications. TRT infusion duration ranged from 3.5 to 6.0 hours (median 4.5). Median contrast dosage was 120 mL (range 50-200). At 24 and 72 hours after EVAR, creatinine clearance (CrCl) had improved in 7 (70%) patients, remained unchanged in 2 (20%), and declined >25% in 1 (10%); the latter returned to baseline on day 5. At 30 days, 7 (70%) patients had improved CrCl and 3 (30%) remained unchanged.


CONCLUSIONS
TRT is feasible during EVAR in high-risk patients. Further investigation is warranted to determine the safety and efficacy of TRT in preserving renal function during EVAR.
Allie
David E
DE
Cardiovascular Institute of the South, Lafayette, LA 70506, USA. david.allie@cardio.com
Lirtzman
Mitchell D
MD
Wyatt
Charles H
CH
Keller
V Antoine
VA
Mitran
Elena V
EV
Hebert
Chris J
CJ
Patlola
Raghotham
R
Veerina
Kalyan K
KK
Walker
Craig M
CM
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D003287:Contrast Media / Q000009:adverse effects*; D018491:Dopamine Agonists / Q000008:administration & dosage*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D018818:Fenoldopam / Q000008:administration & dosage*; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000295:instrumentation; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000009:adverse effects*; D012077:Renal Artery; D051437:Renal Insufficiency / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
D003287:Contrast Media; D018491:Dopamine Agonists; D014665:Vasodilator Agents; D018818:Fenoldopam