Endovascular aneurysm repair assisted by CO2 digital subtraction angiography and intra-operative contrast-enhanced ultrasonography: Single centre experience

Abstract Background Allergy to iodinated contrast (IC) agent and advanced chronic kidney disease (CKD) are major limitations to endovascular repair of abdominal aortic aneurysms (EVAR). We describe our experience combining CO2 assisted EVAR with intraoperative contrast-enhanced ultrasound (CEUS) in an attempt to avoid contrast induced allergy or nephropathy. Methods Observational cohort study using prospectively acquired data on patients undergoing CO2-assisted EVAR in single institution. EVAR planning was performed using computed tomographic angiography or magnetic resonance aortography in patients contraindicated for IC. Patients were considered if their eGFR Results Fifteen patients (10 male) were treated across a 5-year period. Technical success was achieved in all cases. Completely iodinated contrast free EVAR was performed in 9 cases, whilst the remaining 6 required IC administration for adjunct procedures. CO2 completion angiography detected all type I endoleaks (2 Ia & 1 Ib) but was less sensitive to type II. Intraoperative CEUS confirmed all type I and 2 cases of type II endoleaks. Median hospital stay was 4 days. No significant deterioration in renal function was seen post-operatively. Conclusions In patients with abdominal aortic aneurysms and with contraindication for IC, a combined approach of using CO2 digital subtraction angiography and CEUS can be used safely and efficiently to minimize or obviate the need for IC agents with satisfactory mid-term results.