PP146 Use Of Carbon Dioxide In Endovascular Surgery To Prevent Contrast-Induced Nephropathy

Abstract

Introduction

Interventional procedures often use iodinated contrast media (ICM) to visualize the area of interest. However, the use of ICM can cause contrast-induced nephropathy (CIN), which is a frequent complication after catheterization and is associated with morbidity and mortality. CIN is also a common complication in patients with pre-existing chronic kidney disease, diabetes, and heart failure. The purpose of this analysis was to compare carbon dioxide (CO₂) with conventional contrast agents.

Methods

To assess the clinical effectiveness of CO₂ in preventing CIN, a systematic review of relevant literature, including international guidelines, from the Medline database was conducted. Imaging of the chest, aorta, coronary arteries, and cerebral circulation with CO₂ is limited, so effectiveness was determined in the field of renal and peripheral artery angioplasty. The effect on intervention cost was the main outcome.

Results

Use of CO₂ generally reduced renal toxicity and anaphylactic reaction, but the benefits remain controversial. Angiography with CO₂ is reasonable when image accuracy is not crucial due to its low informative value. Strategies for preventing acute kidney injury demonstrated the effectiveness of sodium chloride administration before and after the procedure. Additionally, the absence of risk factors for kidney disease significantly reduced the risk of impaired renal function.

Conclusions

Although CO₂ is one of the alternative methods for visualization, it is not pivotal in preventing CIN, even though the manufacturers recommend CO₂ as the preferred contrast agent in patients with renal insufficiency who are allergic to ICM. The economic indicators for the use of CO₂ are similar to traditional visualization methods.