Transarterial Computed Tomographic Angiography in Patients With Impaired Renal Function Undergoing Endovascular Aortic Repair.

Abstract

PurposeComputed tomography angiography (CTA) is crucial for preoperative planning and postoperative surveillance of endovascular aneurysm repair (EVAR). Renal function impairment however limits pre- and postoperative assessment. The aim of our study was to evaluate the safety and diagnostic value of a novel technique in the setting of patients undergoing EVAR.Methods216 patients with chronic kidney disease undergoing transbrachial placement of an angiography catheter in the aorta for contrast medium administration were analyzed retrospectively. 45 patients with normal kidney function and aortic aneurysms were included as control group. 27 were female, 84 cases were for thoracoabdominal aortic aneurysm, while 106 cases were for abdominal aortic aneurysm. Primary endpoint was the freedom from contrast-induced acute kidney injury. Secondary safety endpoints were freedom from access site complications and cerebrovascular incidents. Imaging quality endpoints were attenuation values and contrast-to-noise-ratios in predefined vessels, validated by intraclass correlation coefficients.ResultsMean creatinine change was -.11 mg/dL, mean GFR change was 2.13% in the intervention group. There were 10 (4.6%) false aneurysms and two access site hematoma (0.93%). Two cerebrovascular incidents (0.9%) were transient. Transarterial CTA attenuation values varied between 210.4 (±89) and 241.4 (±98) Hounsfield units (HU), and 306.35 (±63.27) to 321.39 (±70.12) HU in the control group. The mean amount of contrast medium used in the catheter group was significantly reduced (31.70 ± 5.82 mL) compared to the control group (P = .001). Contrast-to-noise ratios varied between 9.1 (±4.6) and 11.1 (±4.4. Intraclass correlation coefficients between the readings were very good (0.987-0.992).ConclusionCatheter-based transarterial computed tomographic angiography is a safe and efficacious way to evaluate patients with aortic aneurysms, both prior and after EVAR.