title: Lowering iodinated contrast concentration in infrainguinal endovascular interventions: a three-armed randomized controlled non-inferiority trial.
abstract: OBJECTIVE
  To determine the influence of lowering iodinated contrast concentration on confidence of interventional radiologists in diagnosing and treating lesions during endovascular interventions in patients with symptomatic peripheral arterial disease (PAD).
  
  
  METHODS
  A randomized controlled non-inferiority trial was performed in 60 patients. Intervention was performed with contrast concentrations (in mg of iodine per mL, mgI/mL) of 300 (standard), 240, or 140 mgI/mL. Primary outcome was confidence (score 0-100 %) of radiologists in diagnosing and treating arterial lesions. Secondary outcomes were procedural iodine load and image quality (i.e. non-diagnostic, limited, diagnostic, exemplary).
  
  
  RESULTS
  Median confidence scores in diagnosing lesions were 100 % (range 81-100 %) for the 300 group (n = 21), 100 % (range 82-100 %) for the 240 group (n = 19), and 100 % (range 91-100 %) for the 140 group (n = 20) (both p = 1.00 compared to the 300 group). Median scores for treating lesions in the 240 and 140 groups, 100 % (range 79-100 %, p = 0.40), and 100 % (range 63-100 %, p = 0.25), respectively, were not lower compared to the 300 group (median 100 %, range 78-100 %). Procedural iodine load was lower in the 240 (24.3 ± 7.6 g, p = 0.022) and 140 groups (17.8 ± 5.6 g, p < 0.001) compared to the 300 group (29.7 ± 6.3 g). Image quality was diagnostic for all groups.
  
  
  CONCLUSIONS
  Using iodine contrast of 140 mgI/mL for diagnosis and interventions in PAD patients significantly reduces administered iodine load without compromising image quality. Future use of lower iodine dose is recommended.
  
  
  CONCLUSIONS
  • Lower iodinated contrast concentration during endovascular intervention does not decrease radiologist's confidence. • Image quality of standardized angiographies remains diagnostic using 140 mgI/mL iodinated contrast concentration. • Iodine load during intervention can be decreased by >40 % when using 140 mgI/mL. • Implementing the use of a lower iodinated contrast concentration will reduce the costs of the procedure.
authors.affiliation: Department of Radiology, Academic Medical Center, Room G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. s.jens@amc.uva.nl.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Jens
authors.affiliation: Department of Radiology, Academic Medical Center, Room G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Sanne M
authors.initials: SM
authors.lastname: Schreuder
authors.affiliation: Department of Radiology, Academic Medical Center, Room G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Diederik W
authors.initials: DW
authors.lastname: De Boo
authors.affiliation: HagaZiekenhuis, Leyweg 275, 2545 CH, Den Haag, Netherlands.
authors.forename: Lukas C
authors.initials: LC
authors.lastname: van Dijk
authors.affiliation: HagaZiekenhuis, Leyweg 275, 2545 CH, Den Haag, Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: van Overhagen
authors.affiliation: Department of Radiology, Academic Medical Center, Room G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Shandra
authors.initials: S
authors.lastname: Bipat
authors.affiliation: Department of Radiology, Academic Medical Center, Room G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Mark J W
authors.initials: MJ
authors.lastname: Koelemay
authors.affiliation: Department of Radiology, Academic Medical Center, Room G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Jim A
authors.initials: JA
authors.lastname: Reekers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007455:Iodine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging*; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media; D007455:Iodine
keywords: Angiography; Contrast media; Critical limb ischemia; Intermittent claudication; Peripheral arterial disease