Safety and Efficacy of Hybrid Angiography in Chronic Lower Extremity Ischemia Patients at Risk of Contrast-Induced Acute Kidney Injury.

Aim: The aim of the study was to assess the feasibility and safety of hybrid angiography consisting of carbon dioxide (CO 2 ) angiography supplemented by small doses of iodinated contrast medium (ICM) in the endovascular treatment of chronic limb threatening ischemia (CLTI) patients with pre-existing chronic kidney disease (CKD). Patients and Methods: This prospective study comprised all non–dialysis-dependent CKD patients presenting for endovascular management of CLTI. All endovascular interventions were done using CO 2 as a contrast medium whether alone or supplemented by ICM (hybrid angiography) to treat unilateral arterial steno-occlusive lesions of iliac, femoropopliteal, or BTK arteries. Study outcomes included feasibility of the device, technical success, and freedom from contrast-induced acute kidney injury (CI-AKI), renal replacement therapy, and CO 2 angiography-related complications. Results: A total of 206 CKD patients underwent endovascular intervention using CO 2 only as a contrast medium (159 patients, 77.2%), or hybrid CO 2 -ICM angiography (47 patients, 22.8%). The overall technical success was 95.6%. Patients were followed up for a mean period of 17.9 ± 4.6 months. The mean volumes of CO 2 , and ICM consumption were 200.7 ± 95.1 mL, and 11.8 ± 4.4 mL, respectively. The mean procedural, and fluoroscopy times were 95.6 ± 12.5 and 49.5 ± 10.8 minutes, respectively. BTK lesions were significantly associated with the need for hybrid angiography (P = <.0001). The mean pre- and postoperative serum creatinine levels were comparable (P =.08). Two patients (4.3%) showed transient manifestations of CI-AKI, but neither required renal replacement therapy. No statistically significant differences were encountered between the two study groups regarding procedure outcomes. Conclusion: Hybrid CO 2 -ICM angiography is safe, feasible, effective, and a fairly simple alternative during endovascular interventions to treat chronic lower extremity ischemia. Using supplemental small volumes of ICM to overcome the suboptimal images generated by CO 2 alone does not jeopardize the renal functions in CKD patients. [ABSTRACT FROM AUTHOR]

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