Infrapopliteal Carbon Dioxide (CO2) Angiography in Diabetic Patients with Critical Limb Ischemia. Limb Rescue and Prevent Kidney Failure

Abstract

Introduction: The objective of this study is to evaluate the diagnostic and therapeutic carbon dioxide (CO2) angiography below the knee in patients with diabetes mellitus and peripheral arterial vascular disease (PAD). To determine efficacy and diagnostic accuracy of carbon dioxide angiography below the knee Methods: Lower limb angiography below the knee with CO2 (diagnostic and diagnostic-interventional) were collected from the database of our clinic of 129 consecutive patients between 2012 and 2018 and retrospectively reviewed. Of the 129 patients with PAD undergoing CO2 angiography 128 had a admitting diagnose of CRI≥ stage III(GFR< 45, moderate tosevere Kidney function loss) and PAD stage IV. Results: Of the 128 patients undergoing CO2 angiography and CLI, 122 (95%) had diabetes mellitus. Of the patients without known diabetes mellitus at the begin of medical hospitalization, 6 (5%) had a glycated haemoglobin levels above 6.4%. The admitting renal insufficiency was: stage III 62%, stage IV 29% and stage V 9%( with residual excretion). All of them had a necrosis or ulceration in the foot area. Lower limb angiographic procedures with CO2 in diabetics, were performed diagnostically at 9 patients(7%) and diagnostically-interventional at 119 (93%). From the 128 angiography in 36 patients(28%) we did under CO2 at least one crural artery revascularization. Balloon dilatation of 2 crural vessels in the same intervention was performed in 24%. The anterior tibial artery was dilated 63 times, posterior 33 and fibular 49. 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. Early and late limb salvage can be achieved based on CO2 endovascular revascularisation of infrapopliteal arteries. This method can be an important treatment option in diabetic patients to prevent deterioration of renal function in patients with pre-existing renal insufficiency. These patients require quickly and low-risk (kidney-safe) lower limb imaging to help preserve the leg Disclosure: No conflict interset