Renal Benefits of CO2 as a Contrast Media for EVAR Procedures: New Perspectives on 1 Year Outcomes.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Journal of Endovascular Therapy Pub Date : 2024-12-01 Epub Date: 2023-04-18 DOI:10.1177/15266028231162258
Marco Busutti, Alice Sensoni, Andrea Vacirca, Chiara Abenavoli, Chiara Donadei, Anna Laura Croci Chiocchini, Matteo Righini, Giorgia Comai, Alessia Pini, Gianluca Faggioli, Enrico Gallitto, Gaetano La Manna, Mauro Gargiulo
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引用次数: 0

Abstract

Background and objectives: Endovascular aneurism repair (EVAR) is a minimally invasive alternative to open surgery for the treatment of abdominal aortic aneurysm. Iodine contrast medium (ICM) is considered the gold standard, at the high price of related nephrotoxicity and allergic reactions. Carbon dioxide (CO2) has been suggested as an alternative non-nephrotoxic contrast media agent. We aimed to evaluate the safety and the renal impact of the administration of CO2, compared with ICM in EVAR procedures.

Design, setting, participants, and measurements: We retrospectively reviewed data of patients who underwent EVAR at the Vascular Surgery Department of the Sant'Orsola Hospital in Bologna. Estimated glomerular filtration rate (eGFR) was evaluated before intervention, immediately after and at 12 months.

Results: In total, 22 patients received CO2 and low-dose ICM (CO2 Group) and 22 received standard ICM (Control Group), matched for clinical characteristics and renal function at the time of procedure. Pre and post-operative renal function values (eGFR) were compared between the two groups: in the immediate post-operative the group treated with CO2 and low-dose ICM globally showed a slight improvement in renal function (mean eGFR +5.10%±3.2), meanwhile the group treated with standard dose of ICM presented a significant worsening of renal function compared with pre-procedure values (mean eGFR -9.65%±4). Incidence of post-contrast acute kidney injury (PC-AKI) was 9% in the CO2 group vs 27% in the Control group. At 12 months, the renal impairment was significantly greater in the ICM group than in the CO2 group (mean eGFR decrease -19.2%±11.1 and -7.40%±3.5, respectively).

Conclusions: Administration of either CO2 alone or along with low-dose ICM showed to be safer than full-dose ICM alone, lowering the incidence of PC-AKI in patients undergoing EVAR. Unexpectedly, our study revealed also a significant worsening of renal function in patients treated with standard dose of ICM in 1-year follow-up, introducing the concept that acute renal damage caused by ICM could elicit a chronic injury process that affect long-term renal outcomes.

Clinical impact: Evaluating the safety and the renal impact of the administration of CO2, compared to Iodinate Contrast Medium, in EVAR procedures represents a first step in order to further tayloring medical procedures on patients characteristics. Our findings can guide the clinicians and surgeons in the procedures choice, not considering only the immediate effect of ICM on renal function but also the potential long-term effects.

二氧化碳作为 EVAR 手术对比剂对肾脏的益处:1年疗效的新视角。
背景和目的:血管内动脉瘤修补术(EVAR)是治疗腹主动脉瘤开放手术的微创替代方法。碘造影剂(ICM)被认为是黄金标准,但却要付出相关肾毒性和过敏反应的高昂代价。二氧化碳(CO2)被认为是一种无肾毒性的替代造影剂。我们的目的是评估在 EVAR 手术中使用二氧化碳与 ICM 相比的安全性和对肾脏的影响:我们回顾性审查了在博洛尼亚圣奥索拉医院血管外科接受 EVAR 的患者数据。对干预前、干预后和干预后 12 个月的估计肾小球滤过率(eGFR)进行了评估:共有 22 名患者接受了二氧化碳和低剂量 ICM 治疗(二氧化碳组),22 名患者接受了标准 ICM 治疗(对照组)。比较了两组患者术前和术后的肾功能值(eGFR):术后不久,接受二氧化碳和低剂量 ICM 治疗的一组患者的肾功能略有改善(平均 eGFR +5.10%±3.2),而接受标准剂量 ICM 治疗的一组患者的肾功能与术前相比明显恶化(平均 eGFR -9.65%±4)。二氧化碳组对比术后急性肾损伤(PC-AKI)的发生率为 9%,对照组为 27%。12 个月时,ICM 组的肾功能损伤明显高于 CO2 组(平均 eGFR 分别为 -19.2%±11.1 和 -7.40%±3.5):结论:与单独使用全剂量 ICM 相比,单独使用二氧化碳或在使用低剂量 ICM 的同时使用二氧化碳更安全,可降低 EVAR 患者 PC-AKI 的发生率。意想不到的是,我们的研究还发现,接受标准剂量 ICM 治疗的患者在 1 年的随访中肾功能明显恶化,这引入了一个概念,即 ICM 造成的急性肾损伤可能引发慢性损伤过程,从而影响长期的肾脏预后:临床影响:与碘酸盐造影剂相比,评估在 EVAR 手术中施用二氧化碳的安全性和对肾脏的影响是根据患者特征进一步调整医疗程序的第一步。我们的研究结果可以指导临床医生和外科医生选择手术方式,不仅考虑 ICM 对肾功能的直接影响,还考虑潜在的长期影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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