Carbon Dioxide as Contrast Medium to Guide Endovascular Aortic Aneurysm Repair.
BACKGROUND
Iodine contrast medium (ICM) is considered to be gold standard in endovascular procedures, but its nephrotoxicity and hypersensitivity limit the widespread use. Carbon dioxide (CO2) is considered as an alternative for endovascular procedures in patients with contraindication to ICM. However, no studies have compared the outcomes of endovascular aneurysm repair (EVAR) performed with ICM or CO2among patients with no contraindication to ICM.


METHODS
From May 2012 to April 2014, 36 patients with abdominal aortic aneurysms underwent EVAR in a prospective, randomized, and controlled study. Patients were randomized into 2 groups, CO2or ICM group.


RESULTS
We were able to perform the proposed procedures in all patients in this study. There were no conversions to open surgery and no CO2-related complications. Endovascular material costs, duration of surgery, and time of fluoroscopy were similar between groups, and the cost of the contrast media was smaller in the CO2group than in the ICM group. Among CO2group procedures, 62.5% of the patients needed ICM complementary use.


CONCLUSIONS
The use of CO2as a contrast medium for EVAR is an alternative in patients with no restriction for ICM, with similar outcomes when compared to ICM, regarding duration of surgery, duration of fluoroscopy, and endovascular material costs. Using CO2, there were no changes in creatinine clearance and no risk of hypersensitivity reactions; moreover, there was a reduction in contrast-related costs for EVAR procedures. However, in our study, additional use of ICM to visualize the internal iliac artery was needed in most procedures.
Hospital Israelita Albert Einstein, Morumbi, São Paulo, Brazil; Hospital Municipal Dr Moyses Deutsch-Mboi Mirim, Jardim Ângela, São Paulo, Brazil. Electronic address: Cynthiamendes35@hotmail.com.
Cynthia
C
de Almeida Mendes
Hospital Israelita Albert Einstein, Morumbi, São Paulo, Brazil; Hospital Municipal Dr Moyses Deutsch-Mboi Mirim, Jardim Ângela, São Paulo, Brazil.
Alexandre
A
de Arruda Martins
Hospital Israelita Albert Einstein, Morumbi, São Paulo, Brazil.
Marcelo Passos
MP
Teivelis
Hospital Israelita Albert Einstein, Morumbi, São Paulo, Brazil.
Sergio
S
Kuzniec
Hospital Israelita Albert Einstein, Morumbi, São Paulo, Brazil.
Andrea Yasbek Monteiro
AY
Varella
Hospital Israelita Albert Einstein, Morumbi, São Paulo, Brazil.
Nelson
N
Wolosker
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D001938:Brazil; D002245:Carbon Dioxide / Q000008:administration & dosage* / Q000009:adverse effects; D000072226:Computed Tomography Angiography; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D003287:Contrast Media; D002245:Carbon Dioxide; D007472:Iohexol