CO2 Automated Angiography in Endovascular Aortic Repair Preserves Renal Function to a Greater Extent Compared with Iodinated Contrast Medium. Analysis of Technical and Anatomical Details

The optimal operative protocol to accomplish CO2-EVAR resulting from a prospective interventional multicenter study

“…In step 3, the visualization of the contralateral hypogastric artery was 93% with a median good image quality. In our previous experiences, 11,12 the contralateral hypogastric artery was visualized in all cases without any In step 4, the completion CO 2 angiogram provided better images when the injection was performed from the femoral introducer sheath. Again, this result could be misread, because the CO 2 from the introducer was injected after the pigtail injection; the gas still present in the aorta could possibly improve image quality.…”

“…Beside these technical findings, the most relevant result of our study is that CO 2 -EVAR procedures can be completed with a very minimal amount of iodine injection (median, 17 cc [IQR, 51 cc]), similarly to the case series of Fujihara et al 9 and significantly lower compared with our previous experience. 12 The postoperative outcome in terms of mortality (0%) and renal function (0 mg/dL [IQR, 0.08 mg/dL] of median creatinine increase and 0 mL/min [IQR, 6.5 mL/min] of median eGFR decrease) was excellent. As reported before by Fujihara et al 9 it is important to underline that many type II endoleaks visualized during the procedure tend to spontaneously thrombose before the pre-discharge imaging.…”

“…The population group of 65 patients submitted to CO 2 -EVAR compares well with the most numerous experiences in the literature. 8,9,12,15 We have divided the analysis in different steps to precisely evaluate the performance of CO 2 injections. In step 1 analysis, the LoRA, which is obviously crucial for a precise main body deployment, was similarly detected independently from the route of CO 2 injection (ie from pigtail and femoral introducer); however, the latter provided better images (median image quality: pigtail, 2 [IQR, 3] vs introducer, 3 [IQR, 3]; P ¼ .008].…”

“…In fact, some issues regarding the visualization of the lowest renal artery (LoRA) e obviously crucial for a precise endograft main body deployment e or the preferred route of CO 2 injection e either through the pigtail or the introducer sheath e are still unsolved and do not always allow to accomplish zero iodine procedures. 11,12 The aim of this study was to analyze the steps of CO 2 -EVAR procedures steps in terms of LoRA and hypogastric artery (HA) visualization as well as image quality assessment, to create an operative protocol to standardize the procedure and to assess the safety of the technique.…”

Calibrated Hydraulic Resistance Adjuncts for Carbon Dioxide Angiography Optimization

“…Many of the clinical innovations were born in laboratories and operating rooms. An accurate bench-based evaluation of what happens in biomechanical terms for optimizing procedures has rarely been carried out in-depth, and some aspects can be improved [4][5][6].…”