Catheter-less angiography for endovascular aortic aneurysm repair: A new application of carbon dioxide as a contrast agent

Objective: Avoidance of nephrotoxic contrast agents during endovascular repair of abdominal aortic aneurysms (EVAR) may reduce the incidence of renal dysfunction following the procedure. Carbon dioxide (CO2) angiography is a safe alternative to iodinated contrast media vastly under-utilized by vascular surgeons. We herein describe our experience with a simple angiographic technique using CO2 for EVAR guidance that does not require a separate angiographic catheter. Methods: Eighteen patients underwent EVAR using angiography with CO2 delivered through the endograft sheath. The renal and hypogastric arteries were localized for endograft deployment exclusively with CO, in all patients. Completion angiography was done with CO2 in all patients and an additional angiogram with iodinated media was done ill 13 cases. Results: All endograft deployments were done Successfully With CO2 angiography injected through the endograft delivery systems and femoral access sheaths. Additional iodinated media completion angiography did not modify the procedure in any case. All patients were discharged within two days after surgery. There were no ischemic or systemic complications related to CO2 administration. Follow-up CT-scan revealed well positioned endografts with the expected patent renal and hypogastric arteries in all patients, and no additional endoleaks. No significant deterioration in renal function occurred in any case. Conclusion: Carbon dioxide angiography conducted through the endograft delivery sheath is reliable for endograft deployment, safe, non-toxic and inexpensive. In addition, it may expedite EVAR by eliminating a number of angiographic catheter placements and exchanges during the procedure. This favorable experience warrants further utilization of this technique.