PMID- 28648650 OWN - NLM STAT- MEDLINE DCOM- 20180827 LR - 20180827 IS - 1615-5947 (Electronic) IS - 0890-5096 (Linking) VI - 47 DP - 2018 Feb TI - Planning, Execution, and Follow-up for Endovascular Aortic Aneurysm Repair Using a Highly Restrictive Iodinated Contrast Protocol in Patients with Severe Renal Disease. PG - 205-211 LID - S0890-5096(16)30860-3 [pii] LID - 10.1016/j.avsg.2017.06.050 [doi] AB - BACKGROUND: The cumulative amount of iodinated contrast medium necessary for endovascular repair (EVAR) planning, operative procedure, and subsequent follow-up is a threat for the onset of end-stage renal disease in patients with preoperative impaired kidney function. The purpose of this study was to describe a mini-invasive approach aimed to minimize the exposure of these patients to iodinated contrast medium and the subsequent risk of renal function worsening. METHODS: From 2012 to 2015, all patients with abdominal aortic aneurysm (AAA) at high surgical risk and fit for standard EVAR (simple aortic-iliac anatomy: proximal and distal neck length >/=15 mm, no severe angulation), underwent EVAR through the following "near-zero contrast" approach, if their glomerular filtration rate (GFR) was <30 mL/min: preoperative planning was performed by noncontrast-enhanced computed tomography and duplex ultrasound (DU); the origin of renal/hypogastric arteries and aortic bifurcation was evaluated and matched with vertebral bone landmarks and the endograft deployed accordingly, using <20 cc of isotonic iodinate contrast medium and contrast-enhancement DU (CEUS). Follow-up was by DU/CEUS at 1, 6, and 12 months. Primary end points were technical success (TS: renal/hypogastric artery patency, absence of type I/III endoleaks, iliac stenosis/kinking, intraoperative mortality, and conversion), 30-day mortality, and new onset of permanent dialysis with renal function evaluation at 1, 6, and 12 months. Secondary end points were type II endoleaks, reinterventions, AAA, and renal-related mortality during the follow-up. RESULTS: Eighteen patients (median age: 74 years, interquartile range [IQR]: 6, male: 78%, American Society of Anaesthesiologists [ASA] IV: 100%) were enrolled. The median AAA diameter and preoperative GFR were 66 mm (IQR: 13) and 22 mL/min (IQR: 4), respectively. Infrarenal (n = 10) and suprarenal fixation (n = 8) endografts were implanted, with a mean dose of iodinate contrast medium injection of 18 mL (IQR) and 100% TS rate. Two type II endoleaks were detected at the completion CEUS. The median postoperative GFR was 22 mL/min (IQR: 5). No patients had GFR worsening >/=30% at 1 day and 30 days. The 30-day mortality was 11% (2 deaths for heart failure). At a median follow-up of 16 months (IQR: 8), no patients needed hemodialytic treatment and no endoleaks were detected. One patient died at 6 months for cancer and one at 13 months for myocardial infarction. No reinterventions or AAA and renal-related mortality occurred during the follow-up. CONCLUSIONS: A "near-zero contrast" approach is feasible in EVAR for patients with simple aorto-iliac anatomy. Patients with very poor renal function may still undergo to successful procedures, avoiding renal function impairment. CI - Copyright (c) 2017 Elsevier Inc. All rights reserved. FAU - Gallitto, Enrico AU - Gallitto E AD - Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy. Electronic address: enrico.gallitto@gmail.com. FAU - Faggioli, Gianluca AU - Faggioli G AD - Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy. FAU - Gargiulo, Mauro AU - Gargiulo M AD - Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy. FAU - Freyrie, Antonio AU - Freyrie A AD - Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy. FAU - Pini, Rodolfo AU - Pini R AD - Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy. FAU - Mascoli, Chiara AU - Mascoli C AD - Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy. FAU - Ancetti, Stefano AU - Ancetti S AD - Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy. FAU - Vento, Vincenzo AU - Vento V AD - Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy. FAU - Stella, Andrea AU - Stella A AD - Division of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy. LA - eng PT - Journal Article DEP - 20170623 PL - Netherlands TA - Ann Vasc Surg JT - Annals of vascular surgery JID - 8703941 RN - 0 (Contrast Media) RN - 0 (Phospholipids) RN - 0 (contrast agent BR1) RN - WS7LR3I1D6 (Sulfur Hexafluoride) SB - IM MH - Aged MH - Aged, 80 and over MH - Anatomic Landmarks MH - Aortic Aneurysm, Abdominal/complications/diagnostic imaging/mortality/*surgery MH - Aortography/methods MH - Blood Vessel Prosthesis MH - *Blood Vessel Prosthesis Implantation/adverse effects/instrumentation/mortality MH - Clinical Decision-Making MH - Computed Tomography Angiography MH - Contrast Media/*administration & dosage/adverse effects MH - Disease Progression MH - *Endovascular Procedures/adverse effects/instrumentation/mortality MH - Feasibility Studies MH - Female MH - *Glomerular Filtration Rate MH - Humans MH - Kidney/*physiopathology MH - Kidney Diseases/*complications/diagnosis/mortality/physiopathology MH - Kidney Failure, Chronic/diagnostic imaging/*etiology/mortality/physiopathology MH - Male MH - Patient Selection MH - Phospholipids/*administration & dosage/adverse effects MH - Risk Factors MH - Severity of Illness Index MH - Sulfur Hexafluoride/*administration & dosage/adverse effects MH - Time Factors MH - Treatment Outcome MH - Ultrasonography, Doppler, Duplex EDAT- 2017/06/27 06:00 MHDA- 2018/08/28 06:00 CRDT- 2017/06/27 06:00 PHST- 2016/09/19 00:00 [received] PHST- 2017/02/06 00:00 [revised] PHST- 2017/06/06 00:00 [accepted] PHST- 2017/06/27 06:00 [pubmed] PHST- 2018/08/28 06:00 [medline] PHST- 2017/06/27 06:00 [entrez] AID - S0890-5096(16)30860-3 [pii] AID - 10.1016/j.avsg.2017.06.050 [doi] PST - ppublish SO - Ann Vasc Surg. 2018 Feb;47:205-211. doi: 10.1016/j.avsg.2017.06.050. Epub 2017 Jun 23.