O-049 - CARBON-DIOXIDE GUIDED ENDOVASCULAR AORTIC ANEURYSM REPAIR IN IMPAIRED RENAL FUNCTION: PROPENSITY SCORE MATCHING STUDY

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Unal E.U. (Hitit University ~ Corum ~ Turkey) , Iscan H.Z. (Ankara City Hospital ~ Ankara ~ Turkey) , Tumer N.B. (Ankara City Hospital ~ Ankara ~ Turkey) , Erol M.E. (Hitit University ~ Corum ~ Turkey) , Mola S. (Ankara City Hospital ~ Ankara ~ Turkey) , Cetinkaya F. (Ankara City Hospital ~ Ankara ~ Turkey) , Sabir H. (Ankara City Hospital ~ Ankara ~ Turkey) , Mavioglu L. (Ankara City Hospital ~ Ankara ~ Turkey)
Introduction:
Increasing use of iodine contrast medium (ICM) in diagnostic and interventional endovascular procedures causes an increase in renal function impairment caused by contrast-induced nephropathy. Carbon-dioxide (CO2) is the preferred contrast agent in patients with renal failure and/or contrast allergy and particularly in patients who require large volumes of contrast medium for complex endovascular procedures. In this study, we aimed to clarify the possible protective effects of CO2-guided EVAR for patients with impaired renal function by propensity score matching.
Methods:
A retrospective analysis of our database was performed for 324 EVAR patients between January 2019 and January 2022. A total of 34 patients treated with CO2-guided EVAR were evaluated. Angiodroid automated CO2 injection system (Angiodroid SRL, San Lazzaro di Savena, Italy), which was one of the newest generations, offering computerized operation and a highly controlled delivery was used. This cohort was matched for age, gender, preoperative serum creatinine levels and eGFR levels and specific co-morbidities to obtain homogenous groups both including only patients with impaired renal function (eGFR < 60 ml/min). The primary endpoint was to compare the decrease in eGFR from the baseline using propensity score matching. Secondary endpoints were need for renal replacement therapy, effect on development of CIN and mortality.
Results:
Technical success for CO2-guided EVAR was 100%. Duration of procedure and fluoroscopy was similar for unmatched and matched groups. Rate of contrast media usage (needed for accuracy) was 14.7% (5/34 patients) for CO2-guided EVAR group. After matching, decrease in eGFR values after the procedure was more pronounced for the standard-EVAR group (from 44 ml/min to 40 ml/min, interaction p= 0.034). Meanwhile, CIN development was more frequent for the standard-EVAR group (24% vs 3%, p=0.027) and there was 10-fold increased risk of development of CIN at standard EVAR with impaired renal function when compared to CO2-guided EVAR (OR:10.2, 95% CI: 1.2-86.4, p=0.034). In matched patients, early mortality did not differ between the groups (5.9% vs 0, p=0.151)
Conclusion:
Patients with impaired renal function are at higher risk of CIN after endovascular procedure. With modern automated closed systems, CO2-specific complications will be negligible if the operator has experience with the limitations and contraindications of the technique.CO2 guided EVAR is a safe, effective and feasible treatment option especially for patients with decreased renal function. CO2 guided EVAR may be a protective measurement for contrast induced nephropathy.
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