Endovascular therapy by CO2 angiography to prevent contrast-induced nephropathy in patients with chronic kidney disease: a prospective multicenter trial of CO2 angiography registry.
OBJECTIVE
To assess the safety and efficacy of carbon dioxide (CO2) angiography-guided endovascular therapy (EVT) for renal, iliofemoral artery disease.


BACKGROUND
Patients with peripheral vascular disease (PVD) often have chronic kidney disease (CKD) and the use of iodinated contrast media may enhance the risk of contrast-induced nephropathy (CIN). Contrast volume reduction is an effective CIN preventive strategy.


METHODS
A prospective multicenter registry was developed and six clinical centers participated in the study. Patients with an estimated glomerular filtration rate (eGFR) of <60 ml/min/1.73 m2 and stage-3 CKD were recruited between February 2012 and March 2013. CO2 angiography-guided EVT was performed; incomplete CO2 angiograms were supplemented by intravascular ultrasound, pressure wire, and/or minimal iodinated contrast media. The primary endpoint was a composite of freedom from renal events and freedom from major CO2 angiography related complications.


RESULTS
This study included 98 patients with 109 lesions. The mean eGFR baseline was 35.2±12.7 ml min(-1). CO2 angiography-guided angioplasty were performed in 16 renal arteries, 31 aortoiliac arteries, and 62 superficial femoral arteries. The technical success rate was 97.9%. Average CO2 consumption was 281.4±155.8 ml, average dose of iodinated contrast media was 15.0±18.1 ml. Primary endpoint was 92.8% (91/98). Incidence of CIN was 5.1% (5/98) and CO2 angiography-related complications occurred in 17.3% (17/98). Two cases (2%) developed severe, fatal, nonocclusive mesenteric ischemia (NOMI).


CONCLUSIONS
This trial showed that CO2 angiography-guided angioplasty was effective for preventing CIN, however, CO2 angiography related complication was somewhat high.
Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan; Department of Medicine and Biosystemic Science, Kyushu University Graduate, School of Medical Sciences, Fukuoka, Japan.
Masahiko
M
Fujihara
Daizo
D
Kawasaki
Yoshiaki
Y
Shintani
Masashi
M
Fukunaga
Tatsuya
T
Nakama
Ryouji
R
Koshida
Akihiro
A
Higashimori
Yoshiaki
Y
Yokoi
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D002245:Carbon Dioxide; D003287:Contrast Media / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D051437:Renal Insufficiency / Q000139:chemically induced / Q000517:prevention & control*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome
D003287:Contrast Media; D002245:Carbon Dioxide
carbon dioxide angiography; chronic kidney disease; endovascular therapy