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Automated carbon dioxide angiography safe, effective for endovascular interventions
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Use of automated carbon dioxide angiography yielded a high accuracy rate with no treatment-related complications in a group of patients with diabetes, critical limb ischemia and chronic kidney disease, according to recent results.
Researchers conducted a prospective, single-center study of 36 patients with diabetes with critical limb ischemia and chronic kidney disease of stage 3 or higher. The cohort had a median age of 75 years and 27 were men.
All patients underwent automated carbon dioxide angiography, followed by angiography with iodinated contrast medium and subsequent balloon angioplasty between November 2014 and January 2015. Angiography was performed through the common femoral artery using antegrade access in all cases.
The primary outcome was safety and efficacy of automated carbon dioxide angiography. Secondary outcomes included safety and accuracy of automated carbon dioxide angiography in comparison with iodinated contrast medium, as well as amputation-free survival. Safety was assessed according to procedure-related complications at 24 hours and 1 week, and efficacy was evaluated as a composite of procedural success and improvement to transcutaneous oxygen pressure at 30 days.
All procedures were successful, and no patients experienced complications during automated carbon dioxide angiography. The researchers observed improvement in transcutaneous oxygen pressure, from 11.8 ± 6.3 mm Hg to 58.4 ± 7.6 mm Hg at 30 days (P < .001). Estimated glomerular filtration rate did not significantly increase at 24 hours after baseline (44.7 ± 13.3 mL/min/1.73 m2 to 47 ± 0.8 mL/min/1.73 m2). The researchers reported no automated carbon dioxide angiography-related complications at 24 hours or 1 week of follow-up.
No patient required major amputations during follow-up. Minor amputations were performed in 39% of patients.
Carbon dioxide yielded a diagnostic accuracy of 89.8%, sensitivity of 92.3%, specificity of 75%, positive predictive value of 95.5% and negative predictive value of 63.1%. The researchers observed no significant difference in diagnostic accuracy between angiography using carbon dioxide and iodinated contrast medium (P = .197). Involuntary motion of the patient’s limbs or feet during injections was the factor most associated with reduced image quality, according to the researchers.
“Antegrade arterial access and [automated carbon dioxide angiography] performed from the ipsilateral [common femoral artery] is a safe and efficient technique to guide endovascular interventions such as balloon angioplasty in diabetic [critical limb ischemia] patients with advanced [chronic kidney disease],” the researchers concluded. “It provides good diagnostic accuracy even in patients with complex anatomy and comorbidities, and represents a viable option to significantly reduce (or eliminate) the use of iodinated contrast among patients with baseline renal failure.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.
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