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Prevalence of peripheral arterial occlusive disease, among patients with renal failure, is higher than the general population. Angiography is part of those patients workup. Contrast induced nephropathy (CIN) is a major concern in peripheral angiography. Prevention of CIN is of importance among these patients.
Albeit ample evidence support the use of carbon dioxide (CO2) as alternative to contrast medium, Actual utilization rates of this technique are low.
We describe a series of cases in which a combination of CO2 with minimal amount of diluted contrast medium were used for lower extremity angiography.
Eligible PAOD patients with renal failure, (creatinine >2.5 mg/dl or estimated GFR (eGFR) below 30 ml/min/1.73m2) were treated by combination of CO2 and diluted contrast medium. Pre angiography treatment consisted of hydration with 1500 ml of 0.9% saline and 1200mg of N-Acetyl Cysteine. Antegrade puncture, of the ipsilateral femoral artery, was used in all cases. CO2 was used for the femoro-popliteal segment. The infrageniculate arteries were selectively imaged using diluted contrast medium (2 ml of Iomeron 300mOsml diluted with 6 ml of 0.9 % saline) via a catheter placed in the BK popliteal location (Cook KMP 65cm catheter). Pre and post procedure, Doppler examination, were evaluated.
Four patients (50-67 years old), underwent peripheral angiography. Three patients underwent diagnostic and interventional procedures. All 3 patients, underwent infrageniculate percutaneous transluminal angioplasty (PTA), 2 of them underwent femoropopliteal segment PTA, as well. Stent was used in one patient, above and below knee segments, and in one just for the femoropopliteal segment. A median amount of 19ml contrast medium (Iomeron 300mOsml) was used.
ABI increase >25% post treatment was documented in all patients. One patient underwent a diagnostic procedure due to long SFA occlusion. A total amount of 12 ml Iomeron 300mOsml was administered. No adverse effects were noted during and following the procedure.
PAOD patients with chronic renal failure can be effectively treated by endovascular approach combining CO2 and minimal amounts of contrast medium. This simple and feasible technique may be used to preserve renal function in patients with advanced CKD undergoing peripheral endovascular procedures.