E-ISSN 0976-2833 | ISSN 0975-3583
 

Research Article 


Safety and Efficacy of Carbon Dioxide Angiography in the Endovascular Management of Critical Limb Ischemia Patients with Renal Insufficiency

Hussein Khairy, SherifBalbaa, EngieHefnawy, HossamElmahdy, KhaledFekry.

Abstract
Background: This study aims to achieve angioplasty in CLTI patients with renal impairment using CO2 angiography, to assess the clinical outcome with no risk of renal failure and to assess the procedure of CO2 angiography, whether it can be standalone procedure.
Methods: From October 2017 to May 2019, a prospective clinical trial enrolled 35 patients with CLTI associated with renal insufficiency. All were managed using automated CO2 angiography. The primary outcome was assessment of the safety and efficacy of CO2 angiography. The secondary outcome was freedom from renal events.
Results: No serious complications related to CO2 angiography occurred, while severe leg pain occurred in 9 cases (29.7%).Image quality using CO2 angiography was good in 36 lesions (65.5%), accepted in 10 (18%) and poor in 9 (16.5%). We used Iodinated contrast media (ICM) in 33 cases and did not use it in two case one of them due to allergy to iodine. CIN occurred in five patients out of 35 in our study; two out of five with CIN required dialysis while the others recovered to their baseline creatinine level preoperative. The two patients who required dialysis, one of them passed away 1month postoperative due to septic shock while the other required permanent dialysis and had below knee amputation. The only two factors that were statistically significant in predicting the incidence of CIN in our study preoperative creatinine level and amount of (ICM) (p value, 0.008 and 0.001 respectively). There were three cases of mortality in our study (8.5%).
Conclusions: CO2 angiography is safe in the endovascular management of CLTI patients. The diagnostic value of CO2 angiography is the most valuable in the femoropopliteal segment and the least in the infrapopliteal vessels especially in the more distal segments due to motion artefact caused by leg pain during injection. CO2 angiography is poor in showing dissections during endovascular interventions; however, it allows excellent visualization of stents and its struts. CO2 angiography may help to reduce the incidence of CIN by reducing total volume of iodinated contrast during endovascular intervention.

Key words: Carbon dioxide, Angiography, Endovascular, Critical limb ischemia, renal impairment


 
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How to Cite this Article
Pubmed Style

Khairy H, SherifBalbaa , EngieHefnawy , HossamElmahdy , KhaledFekry . Safety and Efficacy of Carbon Dioxide Angiography in the Endovascular Management of Critical Limb Ischemia Patients with Renal Insufficiency. J Cardiovasc. Dis. Res.. 2021; 12(4): 271-286. doi:10.31838/jcdr.2021.12.04.32


Web Style

Khairy H, SherifBalbaa , EngieHefnawy , HossamElmahdy , KhaledFekry . Safety and Efficacy of Carbon Dioxide Angiography in the Endovascular Management of Critical Limb Ischemia Patients with Renal Insufficiency. http://www.jcdronline.org/?mno=92287 [Access: July 26, 2021]. doi:10.31838/jcdr.2021.12.04.32


AMA (American Medical Association) Style

Khairy H, SherifBalbaa , EngieHefnawy , HossamElmahdy , KhaledFekry . Safety and Efficacy of Carbon Dioxide Angiography in the Endovascular Management of Critical Limb Ischemia Patients with Renal Insufficiency. J Cardiovasc. Dis. Res.. 2021; 12(4): 271-286. doi:10.31838/jcdr.2021.12.04.32



Vancouver/ICMJE Style

Khairy H, SherifBalbaa , EngieHefnawy , HossamElmahdy , KhaledFekry . Safety and Efficacy of Carbon Dioxide Angiography in the Endovascular Management of Critical Limb Ischemia Patients with Renal Insufficiency. J Cardiovasc. Dis. Res.. (2021), [cited July 26, 2021]; 12(4): 271-286. doi:10.31838/jcdr.2021.12.04.32



Harvard Style

Khairy, H., SherifBalbaa, ., EngieHefnawy, ., HossamElmahdy, . & KhaledFekry, . (2021) Safety and Efficacy of Carbon Dioxide Angiography in the Endovascular Management of Critical Limb Ischemia Patients with Renal Insufficiency. J Cardiovasc. Dis. Res., 12 (4), 271-286. doi:10.31838/jcdr.2021.12.04.32



Turabian Style

Khairy, Hussein, SherifBalbaa, EngieHefnawy, HossamElmahdy, and KhaledFekry. 2021. Safety and Efficacy of Carbon Dioxide Angiography in the Endovascular Management of Critical Limb Ischemia Patients with Renal Insufficiency. Journal of Cardiovascular Disease Research, 12 (4), 271-286. doi:10.31838/jcdr.2021.12.04.32



Chicago Style

Khairy, Hussein, SherifBalbaa, EngieHefnawy, HossamElmahdy, and KhaledFekry. "Safety and Efficacy of Carbon Dioxide Angiography in the Endovascular Management of Critical Limb Ischemia Patients with Renal Insufficiency." Journal of Cardiovascular Disease Research 12 (2021), 271-286. doi:10.31838/jcdr.2021.12.04.32



MLA (The Modern Language Association) Style

Khairy, Hussein, SherifBalbaa, EngieHefnawy, HossamElmahdy, and KhaledFekry. "Safety and Efficacy of Carbon Dioxide Angiography in the Endovascular Management of Critical Limb Ischemia Patients with Renal Insufficiency." Journal of Cardiovascular Disease Research 12.4 (2021), 271-286. Print. doi:10.31838/jcdr.2021.12.04.32



APA (American Psychological Association) Style

Khairy, H., SherifBalbaa, ., EngieHefnawy, ., HossamElmahdy, . & KhaledFekry, . (2021) Safety and Efficacy of Carbon Dioxide Angiography in the Endovascular Management of Critical Limb Ischemia Patients with Renal Insufficiency. Journal of Cardiovascular Disease Research, 12 (4), 271-286. doi:10.31838/jcdr.2021.12.04.32





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