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Carbon dioxide is a cost-effective contrast medium to guide revascularization of TASC A and TASC B femoropopliteal occlusive disease.
MedLine Citation:
PMID:  24704050     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Data: Iodine contrast media (ICM) is considered gold standard in endovascular revascularization procedures. However nephrotoxicity and hypersensitivity to ICM are causes that limit its indiscriminate use. Carbon dioxide (CO2) contrast angiography has been used as an alternative in patients with formal contra- indication to ICM. However no studies to the present date have compared in a randomized and prospective way, outcomes of revascularization procedures performed with either ICM or CO2 in patients elegible for use of both contrasts METHODS: From april 2012 to april 2013, 35 patients with peripheral arterial disease with arterial lesions classified as TASC A or B (identified on preoperative angioCTscan) and adequate runoff underwent femoropopliteal revascularization by endovascular technique in a prospective, randomized and controlled study. Patients were randomized into 2 groups: CO2 group and ICM group, according to the contrast media selected of the procedure. We evaluated the following outcomes in both groups: feasibility of the procedures, complications, surgical outcomes (ABI index), glomerular filtration rate using the Cockcroft-Gault formula, relationship between the volume of injected iodine and post-operative creatinine clearance; quality of the angiographic images obtained with CO2; costs of the endovascular materials and finally costs of contrast agents.
RESULTS: We were able to perform the proposed procedures in all patients treated in this series (ICM group and CO2). There were no CO2 related complications. No procedures required conversion to open surgery. Clinical results were satisfactory, with regression of ischemia and increased levels of ABI in both groups. Variations in creatinine clearance levels showed a numerical increase in the group CO2 and a decrease in ICM group however with no statistically significant difference between the delta clearance in each group. All CO2 arteriograms of the supra genicular arteries were graded as good or fair by both observers with high inter-observer image quality concordance . There was no statistical difference between endovascular material costs between the groups, but the contrast cost was significantly lower in CO2 group ( p<0,001).
CONCLUSIONS: The use of CO2 in patients with no restriction for ICM is an alternative that does not limit the feasability of the procedures. Similar outcomes were observed with CO2 when compared to the gold standared contrast (ICM) regarding quality of images produced, with no associated changes in creatinin clearence or hypersensitivity reactions and also allows a reduction in contrast-related costs in angioplasty procedures.
Authors:
Cynthia de Almeida Mendes; Alexandre de Arruda Martins; Marcelo Passos Teivelis; Sergio Kuzniec; Kenji Nishinari; Mariana Krutman; Helio Halpern; Nelson Wolosker
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-2
Journal Detail:
Title:  Annals of vascular surgery     Volume:  -     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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