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Use of carbon dioxide as a contrast medium during peripheral endovascular procedures significantly reduces the risk of contrast-induced nephropathy
S74
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Monday
4:12 PM
Scientific Session
Abstract No. 156
Paclitaxel-coated balloon angioplasty (PCBA) use in the treatment critical limb ischemia (CLI)
MONDAY: Scientific Sessions
P. Smith1, U. Turba1, J. Tasse2, S. Madassery3, J. Soni4, O. Ahmed1, B. Arslan1; 1Rush University Medical Center, Chicago, IL; 2Rush University Medical Center, chicago, IL; 3 Affiliated Radiologists, Glenview, IL; 4Rush University Medical Center, Morton Grove, IL. Purpose: To compare our experience using paclitaxel-coated balloon angioplasty (PCBA) of femoropopliteal lesions in patients undergoing revascularization in the setting of CLI compared with current data in the literature. Materials: Angiography, diagnostic imaging, demographics, risk factors, and clinical notes of patients who underwent PCBA from October 2014 to September 2015 for treatment of CLI were reviewed. Study outcome measures include latest follow up study demonstrating luminal patency, amputation and death attributable to CLI. Patients were excluded if PCBA was used within a stent, the target lesion was stented in the same case, treatment was performed with a planned subsequent amputation, or there is lack of any follow up (defined as subsequent ankle-brachial index (ABI), arterial duplex ultrasound, angiography, or clinical exam). Results: A total of 58 stenoses in 41 patients (24 men; mean age 64.8) underwent PCBA during lower extremity revascularization in this interval. Of these, 19 patients (Rutherford class 4, 5, or 6) with 21 lesions met inclusion criteria. These lesions were pretreated with plain-old balloon angioplasty for predilation or atherectomy followed by PCBA. 5 patients were chronically occluded (26%), and 11 (58%) patients also underwent infrapopliteal disease treatment. Average target lesion length was 4.8 cm and luminal narrowing was 79.6%. Mean follow up was 131.7 days (range 8-339 days, median 108 days) and reintervention was performed only in 2 of 21 lesions (92%). Two patients died of other causes with last documented patency at 56 and 83 days follow up. In patients that have available pre and post PCBA ABIs, the average ratio was 0.61 compared to 0.80 following revascularization. Conclusions: Early follow up demonstrates promising patency rates of femoro-popliteal PCBA in the setting of CLI, as well as high rate of concurrent additional infrapopliteal intervention. Current PCBA data in the literature is comprised of significantly lower Rutherford class patients and minimal concurrent infra-popliteal interventions.
4:21 PM
N. Thulasidasan1, L. Patrone2, S. Ilyas2, I. Paraskevopoulos2, A. Diamantopoulos2, R. Dourado2, N. Karunanithy2, K. Katsanos2; 1University Health Network Toronto General Hospital, Toronto, ON; 2 St Thomas’ Hospital, London, UK. Purpose: Contrast-induced nephropathy (CIN) is a leading cause of iatrogenic acute kidney failure. At present CIN
JVIR
prophylaxis prior to endovascular procedures is limited to intravenous hydration, with limited effectiveness. We propose the use of carbon dioxide (CO2) as an adjunct to iodinated contrast for peripheral endovascular procedures, and demonstrate its effectiveness in reducing the incidence of CIN. Materials: From March 2014 to December 2014 CO2 was used as an adjunct to iodinated contrast in all patients with impaired renal function (defined as eGFRo60ml/minute/ 1.73m2) undergoing peripheral endovascular procedures. These cases were matched in a 1:2 ratio with a historical cohort treated using iodinated contrast only between June 2012 and December 2013. Patients’ baseline demographics, use of concomitant hydration and other potentially nephrotoxic medications were recorded. The primary outcome of the study was the incidence of CIN, defined as a 25% or 0.5 mg/dL (44mol/L) increase in serum creatinine within 72 hours of contrast administration. Results: Fifty consecutive patients with critical limb ischaemia (CLI) undergoing endovascular procedures were prospectively enrolled to the CO2 group. The baseline eGFR was 38.6±13.2ml/min/1.73m2, and 68% of patients had diabetes. The matched historical cohort of CLI patients treated using iodinated contrast alone had a baseline eGFR of 43.3±12.2ml/min/1.73m2 and a 65% incidence of diabetes. In the CO2 group the total volume of iodinated contrast used was significantly reduced by nearly 90% compared to the control group (17.8±16.1ml vs. 115.9±57.8ml; po0.001). The incidence of CIN was 14% (n¼7/50) in the CO2 group vs. 29% (n¼29/100) in the matched iodinated contrast-only group (p¼0.045). Receiver operating characteristic curve analysis showed that use of more than 25ml of iodinated contrast was 94.4% sensitive in predicting CIN, with an adjusted odds ratio of 6.9 (95% confidence interval 1.6-30.6). Conclusions: Adjunctive use of CO2 contrast for peripheral endovascular procedures leads to a significant decrease in the incidence of CIN. Usage of no more than 25ml of iodinated contrast should be aimed for in high-risk patients.
Scientific Session 17 Education and Training Monday, April 4, 2016 3:00 PM – 4:30 PM Room: 203/204
Abstract No. 157
Use of carbon dioxide as a contrast medium during peripheral endovascular procedures significantly reduces the risk of contrast-induced nephropathy
’
3:00 PM
Abstract No. 158
The interventional radiology residency: gaining medical student perspective using a survey tool D. Mauro, N. Tabori, R. Patel, E. Kim, F. Nowakowski, R. Lookstein, A. Fischman; Mount Sinai Medical Center, New York, NY. Purpose: With the creation of the IR/DR residency, medical student exposure to IR is critical for recruitment. The purpose
’
Monday
4:12 PM
Scientific Session
Abstract No. 156
Paclitaxel-coated balloon angioplasty (PCBA) use in the treatment critical limb ischemia (CLI)
MONDAY: Scientific Sessions
P. Smith1, U. Turba1, J. Tasse2, S. Madassery3, J. Soni4, O. Ahmed1, B. Arslan1; 1Rush University Medical Center, Chicago, IL; 2Rush University Medical Center, chicago, IL; 3 Affiliated Radiologists, Glenview, IL; 4Rush University Medical Center, Morton Grove, IL. Purpose: To compare our experience using paclitaxel-coated balloon angioplasty (PCBA) of femoropopliteal lesions in patients undergoing revascularization in the setting of CLI compared with current data in the literature. Materials: Angiography, diagnostic imaging, demographics, risk factors, and clinical notes of patients who underwent PCBA from October 2014 to September 2015 for treatment of CLI were reviewed. Study outcome measures include latest follow up study demonstrating luminal patency, amputation and death attributable to CLI. Patients were excluded if PCBA was used within a stent, the target lesion was stented in the same case, treatment was performed with a planned subsequent amputation, or there is lack of any follow up (defined as subsequent ankle-brachial index (ABI), arterial duplex ultrasound, angiography, or clinical exam). Results: A total of 58 stenoses in 41 patients (24 men; mean age 64.8) underwent PCBA during lower extremity revascularization in this interval. Of these, 19 patients (Rutherford class 4, 5, or 6) with 21 lesions met inclusion criteria. These lesions were pretreated with plain-old balloon angioplasty for predilation or atherectomy followed by PCBA. 5 patients were chronically occluded (26%), and 11 (58%) patients also underwent infrapopliteal disease treatment. Average target lesion length was 4.8 cm and luminal narrowing was 79.6%. Mean follow up was 131.7 days (range 8-339 days, median 108 days) and reintervention was performed only in 2 of 21 lesions (92%). Two patients died of other causes with last documented patency at 56 and 83 days follow up. In patients that have available pre and post PCBA ABIs, the average ratio was 0.61 compared to 0.80 following revascularization. Conclusions: Early follow up demonstrates promising patency rates of femoro-popliteal PCBA in the setting of CLI, as well as high rate of concurrent additional infrapopliteal intervention. Current PCBA data in the literature is comprised of significantly lower Rutherford class patients and minimal concurrent infra-popliteal interventions.
4:21 PM
N. Thulasidasan1, L. Patrone2, S. Ilyas2, I. Paraskevopoulos2, A. Diamantopoulos2, R. Dourado2, N. Karunanithy2, K. Katsanos2; 1University Health Network Toronto General Hospital, Toronto, ON; 2 St Thomas’ Hospital, London, UK. Purpose: Contrast-induced nephropathy (CIN) is a leading cause of iatrogenic acute kidney failure. At present CIN
JVIR
prophylaxis prior to endovascular procedures is limited to intravenous hydration, with limited effectiveness. We propose the use of carbon dioxide (CO2) as an adjunct to iodinated contrast for peripheral endovascular procedures, and demonstrate its effectiveness in reducing the incidence of CIN. Materials: From March 2014 to December 2014 CO2 was used as an adjunct to iodinated contrast in all patients with impaired renal function (defined as eGFRo60ml/minute/ 1.73m2) undergoing peripheral endovascular procedures. These cases were matched in a 1:2 ratio with a historical cohort treated using iodinated contrast only between June 2012 and December 2013. Patients’ baseline demographics, use of concomitant hydration and other potentially nephrotoxic medications were recorded. The primary outcome of the study was the incidence of CIN, defined as a 25% or 0.5 mg/dL (44mol/L) increase in serum creatinine within 72 hours of contrast administration. Results: Fifty consecutive patients with critical limb ischaemia (CLI) undergoing endovascular procedures were prospectively enrolled to the CO2 group. The baseline eGFR was 38.6±13.2ml/min/1.73m2, and 68% of patients had diabetes. The matched historical cohort of CLI patients treated using iodinated contrast alone had a baseline eGFR of 43.3±12.2ml/min/1.73m2 and a 65% incidence of diabetes. In the CO2 group the total volume of iodinated contrast used was significantly reduced by nearly 90% compared to the control group (17.8±16.1ml vs. 115.9±57.8ml; po0.001). The incidence of CIN was 14% (n¼7/50) in the CO2 group vs. 29% (n¼29/100) in the matched iodinated contrast-only group (p¼0.045). Receiver operating characteristic curve analysis showed that use of more than 25ml of iodinated contrast was 94.4% sensitive in predicting CIN, with an adjusted odds ratio of 6.9 (95% confidence interval 1.6-30.6). Conclusions: Adjunctive use of CO2 contrast for peripheral endovascular procedures leads to a significant decrease in the incidence of CIN. Usage of no more than 25ml of iodinated contrast should be aimed for in high-risk patients.
Scientific Session 17 Education and Training Monday, April 4, 2016 3:00 PM – 4:30 PM Room: 203/204
Abstract No. 157
Use of carbon dioxide as a contrast medium during peripheral endovascular procedures significantly reduces the risk of contrast-induced nephropathy
’
3:00 PM
Abstract No. 158
The interventional radiology residency: gaining medical student perspective using a survey tool D. Mauro, N. Tabori, R. Patel, E. Kim, F. Nowakowski, R. Lookstein, A. Fischman; Mount Sinai Medical Center, New York, NY. Purpose: With the creation of the IR/DR residency, medical student exposure to IR is critical for recruitment. The purpose