Carbon dioxide (Co2) Angiography in Diabetic Patients with Peripheral Arterial Disease and Chronic Renal Insufficiency as a Standard Procedure

Abstract

Introduction - The objective of this study is to evaluate the diagnostic and therapeutic carbon dioxide (CO2) angiography in patients with diabetes mellitus, peripheral arterial vascular disease (PAD) and chronic renal insufficiency (CRI) to determine whether to use of carbon dioxide angiography in this type of patients should be a standard. Methods - Lower limb angiographic procedures with CO2 (diagnostic and diagnostic-interventional) were collected from the database of our clinic of 205 consecutive patients between 2012 and 2017 and retrospectively reviewed. Of the 205 patients with PAD undergoing CO2 angiography 196 had a admitting diagnose of CRI≥ stage III(GFR<45, moderate to severe Kidney function loss) and 9 patients had a iodinated contrast medium hypersensitivity Results - Of the 205 patients undergoing CO2 angiography, 122 (60%) had diabetes mellitus. 18% Had PAD Fontaine stage II, 20% stage III and 62% stage IV. Of the patients without known diabetes mellitus at the begin of medical hospitalization, 29 (35%) had a glycated haemoglobin levels above 6.1%. Of the diabetic patients 116 (95%), had CRI≥ stage III (stage III 47%, stage IV 45% and stage V with residual excretion 8%). However of the 116 diabetics with CRI≥ stage III, the CRI was only known at 74%. Of the remainder of the 24% (30 patients) with unknown CRI, 20 had CRI stage III and 10 had stage IV. Lower limb angiographic procedures with CO2 in diabetics, were performed diagnostically at 30% and diagnostically-interventional at 70%. Balloon dilatation was performed in 81% of diagnostic interventional angiographies (30% crural) and in 19% was placed a stent. Postinterventionall, 95% of patients didn’t have any deterioration of the renal parameters. Conclusion - CO2-guided angiographies are technically safe; reduce the need of a iodinated contrast medium(ICM) application, prevent deterioration of renal function in patients with pre-existing renal insufficiency. This study shows diabetic patients with PAD as an increased risk patient for CNI. As shown, 95% of patients with diabetes who also had PAD, had CRI ≥stage.III at the same time. These patients require quickly and low-risk (kidney-safe) lower limb imaging to help preserve the leg. A ICM examination is contraindicated in these patients and CO2 angiography should be used as the standard, so that no comparison group could be produced to compare the results. Despite the CO2 angiography, 30% of the patients were able to undergo a crural balloon dilatation. The study shows the high rate of diabetic patients with PAD with a not necessarily known CRI, in which CO2 angiography should be used as a standard.