The role of carbon dioxide angiography in reducing contrast-induced nephropathy in diabetic foot patients undergoing endovascular treatment.

Abstract

Background/aim: This study investigates the role of carbon dioxide (CO₂) angiography, delivered with an automated CO₂ delivery system, in decreasing the amount of iodinated contrast and preventing contrast-induced nephropathy (CIN) in diabetic foot patients who underwent endovascular revascularization.

Materials and methods: A total of 272 diabetic foot patients who underwent endovascular treatment for infrainguinal chronic peripheral arterial disease (PAD) were included in the study. Of these, 64 patients underwent endovascular intervention using CO₂ angiography (study group), while 208 patients underwent endovascular intervention using only contrast media (control group). The rates of CIN and the amount of contrast used during interventions were recorded alongside secondary outcomes, including technical success, complication rates, and complications related to CO₂ usage.

Results: The mean contrast volume used in the CO₂ group was significantly lower than in the control group (24.3 ± 13.3 cc vs 89.4 ± 24.8 cc; p < 0.001). CIN was detected in 41 patients. The incidence of CIN was 17.7% in the control group, while it was significantly lower in the CO₂ group at 6.2% (p = 0.024). In a subgroup of patients with chronic kidney disease stage 3-5, CIN incidence remained significantly lower in the CO₂ group (6.2% vs 38.2%, p < 0.001), and multivariate analysis identified CO₂ use as an independent protective factor (OR: 0.027, 95% CI: 0.005-0.133, p < 0.001). Technical success rates were comparable between the groups (93.7% vs 93.2%; p = 0.892). Pain after CO₂ injection was recorded in 11 patients, and no other adverse effect due to CO₂ usage was observed. There were no major complications, and only minor complications occurred (8%).

Conclusion: CO₂ angiography may play a crucial role in minimizing the risk of CIN in this specific population, who are more vulnerable to this complication and its associated morbidity and mortality. Further multicenter prospective studies are needed to better define the role of CO₂ angiography in high-risk patients.