title: Catheter-less angiography for endovascular aortic aneurysm repair: a new application of carbon dioxide as a contrast agent.
abstract: OBJECTIVE
  Avoidance of nephrotoxic contrast agents during endovascular repair of abdominal aortic aneurysms (EVAR) may reduce the incidence of renal dysfunction following the procedure. Carbon dioxide (CO(2)) angiography is a safe alternative to iodinated contrast media vastly under-utilized by vascular surgeons. We herein describe our experience with a simple angiographic technique using CO(2) for EVAR guidance that does not require a separate angiographic catheter.
  
  
  METHODS
  Eighteen patients underwent EVAR using angiography with CO(2) delivered through the endograft sheath. The renal and hypogastric arteries were localized for endograft deployment exclusively with CO(2) in all patients. Completion angiography was done with CO(2) in all patients and an additional angiogram with iodinated media was done in 13 cases.
  
  
  RESULTS
  All endograft deployments were done successfully with CO(2) angiography injected through the endograft delivery systems and femoral access sheaths. Additional iodinated media completion angiography did not modify the procedure in any case. All patients were discharged within two days after surgery. There were no ischemic or systemic complications related to CO(2) administration. Follow-up CT-scan revealed well positioned endografts with the expected patent renal and hypogastric arteries in all patients, and no additional endoleaks. No significant deterioration in renal function occurred in any case.
  
  
  CONCLUSIONS
  Carbon dioxide angiography conducted through the endograft delivery sheath is reliable for endograft deployment, safe, non-toxic and inexpensive. In addition, it may expedite EVAR by eliminating a number of angiographic catheter placements and exchanges during the procedure. This favorable experience warrants further utilization of this technique.
authors.affiliation: Cardiovascular Center, Sections of Vascular Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA. ecriado@umich.edu
authors.forename: Enrique
authors.initials: E
authors.lastname: Criado
authors.forename: Loay
authors.initials: L
authors.lastname: Kabbani
authors.forename: Kyung
authors.initials: K
authors.lastname: Cho
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D001011:Aorta / Q000473:pathology* / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002245:Carbon Dioxide / Q000009:adverse effects; D002406:Catheterization, Peripheral; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced; D008297:Male; D010388:Pelvis / Q000098:blood supply; D015641:Radiography, Interventional; D012077:Renal Artery / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; D002245:Carbon Dioxide; C044834:iodixanol