title: Endovascular repair of ruptured aortic aneurysms using carbon dioxide contrast angiography.
abstract: BACKGROUND
  Endovascular aneurysm repair (EVAR) has become a common approach to the management of ruptured abdominal aortic aneurysms (rAAA). The use of iodinated contrast during EVAR for rAAA has several disadvantages, including contrast nephropathy, potential allergic response, and the need for high-pressure injection. We evaluated the use of carbon dioxide (CO(2)) as the primary contrast agent for endovascular repair of ruptured aortic aneurysms.
  
  
  METHODS
  Between December 2007 and July 2009, we retrospectively reviewed our experience with patients undergoing endovascular repair of rAAA, with CO(2)as the principal contrast agent, and compared them with patients who underwent EVAR using iodinated contrast.
  
  
  RESULTS
  Four patients underwent endovascular repair of rAAA with CO(2) angiography (group 1) and seven with iodinated contrast (group 2). The mean age of the patients was not different between groups (p = 0.353). Patients in group 1 received a mean of 443 ± 99 mL of CO(2) and 4.3 ± 8.5 mL of iodinated contrast. Patients in group 2 received 110.2 ± 37.6 mL of iodinated contrast (p < 0.001). Overall mortality was not different between group 1 (0.0%) and group 2 (28.6%, p = 0.491). In patients who survived to discharge, the change in creatinine between admission and discharge was greater in group 2 although not statistically significant (0.25 ± 0.19 mg/dL for group 1 vs. 0.58 ± 0.25 mg/dL for group 2, p = 0.066). There was no significant difference in length of stay between group 1 (intensive care unit, 1.00 ± 0.82 days; hospital, 4.25 ± 0.96 days) and group 2 (intensive care unit, 3.60 ± 3.44 days; hospital, 9.00 ± 6.60 days).
  
  
  CONCLUSIONS
  Endovascular repair of rAAA using CO(2) as a contrast agent is technically feasible and safe. The potential benefits of CO(2) angiography support the continued use of CO(2) in cases of ruptured aneurysms. Further studies are necessary to determine whether CO(2) improves survival and limits the progression of renal dysfunction after endovascular repair of rAAA.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Knipp
authors.forename: Guillermo A
authors.initials: GA
authors.lastname: Escobar
authors.forename: Sean
authors.initials: S
authors.lastname: English
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Upchurch
authors.forename: Enrique
authors.initials: E
authors.lastname: Criado
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000009:adverse effects / Q000379:methods*; D002245:Carbon Dioxide / Q000009:adverse effects; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control; D007902:Length of Stay; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D002245:Carbon Dioxide