Chronic kidney disease is a common comorbidity in patients with peripheral artery disease. We investigated the safety and efficacy of carbon dioxide (CO2) as supplemental contrast agent to decrease contrast volume during fluoroscopy-guided peripheral vascular procedures in routine angiological practice. We analyzed 191 consecutive interventions of the lower extremity in claudicants and critical limb ischemia (CLI) that were performed with iodinated contrast media (ICM) alone (n = 154) or with the aided or exclusive use of CO2 (n = 37). The technical success rate, total irradiation, and intervention time were not significantly different between ICM and CO2 No severe procedure-related complications occurred. The contrast volume was lower in CO2 than in ICM. Although kidney function, creatinine, and estimated glomerular filtration rate was lower in CO2 at baseline, the incidence of contrast-induced nephropathy was lower in CO2 compared to ICM. These data support CO2 as an alternative supplemental contrast agent that can be applied safely and efficiently to lower contrast volume during peripheral vascular interventions preventing kidney dysfunction even in patients with disease of the popliteal artery and below the knee and CLI.

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Background: The choice between immunotherapy with a checkpoint inhibitor (CPI) and chemo-/immunotherapy (CIT) in patients with NSCLC stage IV is often discussed. There is some data that the effect of CPI-therapy is impaired by antimicrobial therapy (AMT). Little is known about the influence of AMT on CIT. Patients and methods: We retrospectively analysed 114 patients (age 68 ± 8.5 y) with NSCLC stage IV. Patients were treated according to the guidelines with either CPI alone (pembrolizumab, nivolumab, atezolizumab, cemiplimab) or CIT (Carboplatin/Pemetrexed/Pembrolizumab, Carboplatin/Paclitaxel/Pembrolizumab). We registered patients’ characteristics including presence and timing of AMT. Group 1 consisted of 42 patients with AMT in the month before CPI or CIT, group 2 were 49 patients with AMT during CPI or CIT, and group 3 were 64 patients without AMT and CPI or CIT. Results: Group 1-3 showed comparable patients characteristics. Using cox-regression analysis, we found that AMT in the month before CPI resulted in a decreased progression free survival (PFS) compared to patients with CPI and no AMT (14 ± 1.02 vs. 4 ± 1.02 months, p = 0.002, 95% CI: 1.88-9). In patients, who were treated with CIT, there was no difference in PFS in those with or without AMT in the month before therapy (10 ± 2.5 vs. 6 ± 1.2 months, p = 0.7). Interestingly, AMT during CIT or CPI therapy showed no effect on PFS. Conclusions: In a real-life setting, we found that AMT reduces PFS when given in the month before CIT therapy. AMT before or during CIT does not seem to influence PFS. As a consequence, AMT before start of therapy might be a factor that could lead to a preference of CIT instead of CPI in NSCLC stage IV patients

ZusammenfassungDie Ätiologie chylöser Aszites ist multifaktoriell. Maligne Grunderkrankungen, Leberzirrhose, Traumata, Lymphanomalien und Mykobakteriosen sind die häufigsten Ursachen. Bei NSCLC wird chylöser Aszites bei einer peritonealen Metastasierung oder abdomineller Lymphknotenmetastasen beobachtet.RET-Alterationen treten bei 1–2% der NSCLC-Patienten auf und können seit kurzem zielgerichtet therapiert werden.Unsere Kasuistik zeigt, dass neue zielgerichtete Therapien die Prognose revolutionieren, uns aber vor die Herausforderung neuer und teils unbekannter Nebenwirkungen stellen.

ZusammenfassungEin 33-jähriger Mann stellte sich wegen langsam progredienter Luftnot vor. Bei der Untersuchung fielen ein Pleuraerguss rechts, Lymphödem linker Unterschenkel und Fuß und fleckige, landkartenartige Hautveränderungen auf. Bei der Pleurapunktion rechts konnte ein chylöser Erguss abgelassen werden. In der Ganzkörper-MRT war der Pleuraerguss rechts nachweisbar, eine Vermehrung der Lymphgefäße inguinal, parailiakal und paraaortal und prominente Chylusgefäße. Eine ossäre Beteiligung lag nicht vor. Der Ductus thoracicus abdominalis war bis auf 3 mm erweitert. Wir stellten die Diagnose einer generalisierten lymphatischen Anomalie (GLA) – Lymphangiomatose. Die GLA ist eine seltene Erkrankung unbekannter Ursache mit Fehlentwicklung des lymphatischen Systems. Thorakal fällt eine GLA oft durch die Entwicklung von chylösen Pleuraergüssen auf. Es können aber auch viele andere Organe betroffen sein. Die Therapie besteht meist in einer symptomatischen Behandlung und dem Versuch, den Progress der Erkrankung zu verlangsamen.