VESS24. The Benefit of Combined CO2 Automated Angiography and Fusion Imaging in Preserving Perioperative Renal Function in Fenestrated Endografting

Abstract Background Contrast induced nephropathy is a possible adverse event in fenestrated endografting (FEVAR). Automated CO2-angiography has been proposed as an alternative to iodinated contrast media (ICM) for standard endovascular aneurysm repair; however, its use in FEVAR has not been investigated yet. The aim of this study was to analyze the possibility of reducing the amount of procedural ICM during FEVAR by combining CO2 with intraprocedural 3D preoperative computed tomography angiography overlaid onto 2D live fluoroscopic images (fusion imaging - FI). Methods Between January and April 2018, juxta/para-renal and type-IV thoracoabdominal aneurysms undergoing FEVAR with a CO2+FI protocol were prospectively collected and compared with FEVAR cases treated with standard procedural imaging (ICM+FI) between June and December 2017. Pre, intra and post-operative data were analyzed. Amount of ICM, procedural/fluoroscopy time, total radiation dose (DAP), endoleaks (EL) and technical success (TS) – defined as absence of type I/III EL and target visceral vessels patency at completion angiography - were assessed. 30-day renal function worsening - eGFR reduction >25% of the preoperative value – and 6-month re-interventions were also considered. Analysis was done by Fisher’s exact and Mann-Whitney tests. Results Forty-five patients were enrolled, 15(33%) managed by CO2+FI and 30(67%) by ICM+FI. The two groups were homogeneous in their clinical, anatomical and endograft features. Median ICM administration was significantly lower in CO2+FI compared with ICM+FI [41 (IQR:26) vs 138.5 (IQR:88) mL; P.001]. There was no difference in median procedural time, fluoroscopy time and DAP between CO2+FI and ICM+FI. Intra-operative ELI/III detection was similar (P =1) in CO2+FI (7%) vs ICM+FI (7%), with immediate repair and TS achieved in all cases. Early ELII did not differ in the two groups (CO2+FI: 27% vs ICM+FI: 20%; P.7). Postoperative renal function deteriorated in 2 (13%) patients in CO2+FI vs 8 (27%) in the ICM+FI group (P.04). The median increase of post-operative creatinine was smaller in CO2+FI than ICM+FI [0.09 (IQR:0.03) vs 0.3 (IQR:0.4) mg/dL; P.04]. The median hospitalization time was shorter in CO2+FI [5 (IQR:1) vs 8 (IQR:4) days; P.002]. No reintervention was necessary at 30-day and 6-month follow-up in either group. Conclusions CO2+FI is safe and effective in FEVAR and allows the amount of ICM to be significantly reduced, leading to shorter hospitalization time and better renal function preservation at 30 days. TS, procedure/fluoroscopy time, radiation dose and 6-month reinterventions are comparable with standard ICM imaging protocol for FEVAR. Based on this preliminary experience, CO2+FI may be proposed as an effective tool to reduce the overall amount of procedural ICM, with consequent benefits on perioperative renal function.