Use of Co2 Angiography for Complex Endovascular Aneurysm Repair

Complex EVAR involving fenestrated and branched endografts, is associated with significant post operative complications. Increased use of iodinated contrast medium is associated with post operative contrast medium induced renal dysfunction and renal failure. We describe the use of CO2 as the primary contrast agent in patients undergoing complex EVAR. Two cohorts of patients undergoing fenestrated and branched EVAR were compared at a regional vascular unit. 68 complex endografts were implanted between 2008 and 2010; 41 procedures were completed with iodinated contrast media (group 1) and 27 utilised CO2 as the primary contrast agent (group 2). Endpoints assessed were need for renal replacement therapy or renal impairment, defined as increase in creatinine of >25%. Baseline renal function was similar in each group (creatinine group 1 median=96; group 2 median=102, (P=0.21)). There was a significant difference in the median change in post op creatinine (28.5 in group 1 compared to 9.5 in group 2 (P=0.048)). However, there was no significant difference in postoperative renal dysfunction (13/41 in group 1 and 8/27 in group 2 (P=0.79)) or need for temporary renal support (7/41 in group 1 and 3/27 in group 2 (P=0.72). No patients required permanent dialysis. Median volume of iodinated contrast used fell from 226.25ml to 75ml (p=0.43). There was no difference between the groups in fluoroscopy time or radiation dose. Renal impairment is a common post-operative complication amongst patients undergoing complex EVAR, although its aetiology is multi-factorial. CO2 angiography can be successfully used for complex EVAR and its use may reduce the volume of iodinated contrast used as well as lower post operative creatinine levels.