Carbon dioxide (CO₂) angiography as an option for endovascular abdominal aortic aneurysm repair (EVAR) in patients with chronic kidney disease (CKD)

To assess feasibility, efficacy and safety of carbon dioxide (CO₂) digital subtraction angiography (DSA) to guide endovascular aneurysm repair (EVAR) in a cohort of patients with chronic kidney disease (CKD). After Ethical Committee approval, the records of 13 patients (all male, mean age 74.6 ± 8.0 years) with CKD, who underwent EVAR to exclude an abdominal aortic aneurysm (AAA) under CO₂ angiography guidance, were reviewed. The AAA to be excluded had a mean diameter of 52.0 ± 8.0 mm. CO₂ angiography was performed by automatic (n = 7) or hand (n = 6) injection. The endograft was correctly placed and the AAA was excluded in all cases, without any surgical conversions. Two patients (15.4%) had an endoleak: one type-Ia, detected by CO₂-DSA and effectively treated with prosthesis dilatation; one type-III, detected by CO₂-DSA, confirmed using 10 ml of ICM, and conservatively managed. In one patient, CO₂ angiograms were considered of too low quality for guiding the procedure and 200 ml of ICM were administered. Overall, 11 patients (84.6%) underwent a successful EVAR under the guidance of the sole CO₂ angiography. No patients suffered from major complications, including those typically CO₂-related. Two patients suffered from abdominal pain during the procedure secondary to a transient splanchnic perfusion’s reduction due to CO₂, and one patient had a worsening of renal function probably caused by a cholesterol embolization during the procedure. In patients with CKD, EVAR under CO₂ angiography guidance is feasible, effective, and safe.