Contrast Free Approach of Patients with Abdominal Aortic Disease and Renal Insufficiency

Abstract

Introduction - Diagnosis and endovascular treatment of Abdominal Aortic diseases could expose patients to worsening of renal function due to the use of iodinated contrast medium. We report a specific contrast medium free approach for patients with abdominal aortic disease and moderate/severe renal insufficiency. The protocol includes: an accurate assessment of chronic kidney disease (CKD), a preoperative evaluation with Duplex ultrasound (DUS) and CT-Scan Contrast Medium free, an intravascular ultrasound (IVUS) and AFX2 Endologix endoprosthesis. Methods - Since November 2017 twenty consecutive patients with aortic disease suitable for EVAR were treated (14 abdominal aortic aneurysm and 6 penetrating aortic ulcer). All patients underwent DUS examination of the aorta (thrombus volume, aneurysm diameter), iliac and femoral arteries and tests to evaluate kidney function. Patients were divided into two groups: 8 patients presenting mild/severe CKD (defined as Glomerular filtration rate less than 40 mL/min/1.73 m2) were evaluated with CT-Scan contrast medium free and IVUS. This group was compared with 12 patients with normal renal function in which a standard evaluation with pre-operative angioCT-scan was performed. Angiography was used only to check the level of lower renal artery and endoleaks with a total injection of 16 ml of contrast medium. All patients underwent EVAR using AFX2 stent graft under local anaesthesia. Results - EVAR was successfully completed percutaneously in 19/20 patients: one open access was needed due to hostile femoral bifurcation. In all patients with moderate/severe CKD the aortic diseases were evaluated and successfully treated without the use of contrast medium. No coverage of renal arteries origin and worsening of renal function were documented in either groups. There was no difference in operative time between the two groups. In addition, IVUS catheter manoeuvres themselves did not cause any major adverse events. Conclusion - Our promising experience suggests that a contrast free approach is a safe and valid option for patients with aortic diseases and moderate/severe renal insufficiency.