Carbon Dioxide Use As A Kidney-Sparing Contrast Agent In Renal Artery Percutaneous Interventions
GABRIELA VELAZQUEZ RAMIREZ, MD, DAVID CROUSE, JEANETTE STAFFORD, MS, NITIN GARG, MD, JUSTIN HURIE, MD, RANDOLPH GEARY, MD, MATTHEW EDWARDS, MD.
Wake Forest University School of Medicine, WINSTON-SALEM, NC, USA.
OBJECTIVES: Atherosclerotic renovascular disease (aRVD) is a common vascular pathology frequently associated with impaired kidney function. Renal artery angioplasty and stent placement (RA-PTAS) requires the use of potentially nephrotoxic and allergenic intra-arterial contrast agents to detail renal anatomy, evaluate options for treatment, and determine technical success after intervention. We reviewed our institutional experience with the use of carbon dioxide, which has no known renal toxicity or allergenic potential, as an alternative and adjunct contrast agent in the performance of RA-PTAS
METHODS: Using an IRB-approved institutional vascular registry, consecutive patients undergoing RA-PTAS for aRVD using carbon dioxide were selected for evaluation. Demographics, indications for revascularization, medical co-morbidities, procedural specifics, and outcomes were recorded and examined. More than 20% change in glomerular filtration rate (GFR) was considered significant. Descriptive specifics were calculated using SAS and reported (where appropriate) as count, mean +/- SD, and median as appropriate.
RESULTS: RA-PTAS was performed in 41 patients with carbon dioxide as an intra-arterial contrast agent. 24 patients were female and 37 patients were Caucasian with a mean age of 72 ± 9 years. 15 (37%) patients were diabetic and all patients (100%) were hypertensive. Mean serum creatinine and eGFR were 1.8±0.6 mg/dl (range 0.7-_3.5 mg/dl) and 40±20ml/min (range 17-119 ml/min), respectively. Technical procedural success was 97%. 6 RA-PTAS procedures used carbon dioxide as the sole contrast agent and 35 as an adjunct contrast agent. The median iodine-based contrast use was 32 ml. Median fluoroscopy time was 361 seconds. At one year, only one patient (2.4%) progressed to permanent dialysis. At early follow-up, 19% of patients demonstrated significantly improved (>20% increase) and 19% demonstrated significantly worsened eGFR. There was only one case of significant morbidity which was myocardial infarction
CONCLUSIONS: RA-PTAS using carbon dioxide as the sole arterial contrast agent or as an adjunct with iodine-based contrast, is a safe and effective option in the treatment of patients with aRVD with significant renal function impairment
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