Endovascular aortic repair via carbon-dioxide imaging in renal insufficiency?

Aim: In our study, we aimed not only if CO2 is a safe and effective vascular roadmap for EVAR procedure instead of ICM but if it is a feasible opportunity for patients with hostile neck anatomy as well. Material and Methods: From January 2019 to July 2022, 42 patients with renal insufficiency had elective EVAR procedures for infrarenal abdominal aortic aneurysm in our Cardiovascular Surgery Clinic with CO2-guided DSA. Results: There were no conversions to open surgery or no need for ICM for the CO2-guided DSA. Technical success for CO2 guidance EVAR was 100% with the second shot. There was no decline in GFR values, only one patient showed transient manifestations of CIN without need for hemodialysis. Conclusion: CO2 DSA is a safe and effective technique that can guide not only the standard but endovascular procedures with a hostile neck for renal insufficiency below the diaphragm allowing virtually unlimited images. With modern automated closed systems, CO2-specific complications will be negligible if the operator has experience with the limitations and contraindications of the technique.