Intra-arterial catheter-directed CT angiography for assessment of endovascular aortic aneurysm repair


Autoři: Marco V. Usai aff001;  Mirjam Gerwing aff002;  Antje Gottschalk aff003;  Peter Sporns aff002;  Walter Heindel aff002;  Alexander Oberhuber aff001;  Moritz Wildgruber aff002;  Michael Köhler aff002
Působiště autorů: Department of Vascular and Endovascular Surgery, University Hospital Münster, Münster, Germany aff001;  Department of Clinical Radiology, University Hospital Münster, Münster, Germany aff002;  Department of Anesthesiology, Intensive Care and Pain Medicine, Münster, University Hospital Münster, Germany aff003
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0221375

Souhrn

Objective

To compare the efficacy and safety as well as associated image quality of catheter-directed CT angiography (CCTA) with a low dose of iodine contrast agent compared to intravenous CTA in patients undergoing endovascular aortic aneurysm repair (EVAR).

Methods

Retrospective data analysis of 92 patients undergoing EVAR between January 2009 and December 2017 was performed. Patients were divided in two groups; those receiving CTA (n = 59) after intravenous contrast agent application and those receiving CCTA (n = 33) via an intraarterial catheter placed in the descending aorta. Demographic and cardiovascular risk factors as well as renal function parameters before, immediately after and 6–60 months after EVAR were evaluated. As primary endpoint, changes in serum creatinine levels in the two groups were evaluated. Secondary endpoints encompassed complications associated with intraarterial catheter placement. Objective (signal-to-noise ratios) and subjective image quality (5-point Likert scale) were compared.

Results

Amount of contrast medium was significantly lower in CCTA compared to i.v. CTA (23 ± 7 ml vs. 119 ± 15 ml, p<0.0001). Patients undergoing catheter-directed CTA had higher baseline creatinine values compared to the group with intravenous iodine application (1.9 ± 0.6 mg/dl vs. 1.3 ± 0.5 mg/dl; p<0.0001). Follow-up serum creatinine levels however did not show significant alterations between the two groups (1.9 ± 0.4 mg/dl vs. 1.3 ± 0.5 mg/dl). No major complications were detected in the CCTA group. Signal-to-noise ratio (SNR) was comparable between i.v. CTA and CCTA (8.5 ± 4.6 vs. 7.7 ± 4.0; p = 0.37) and subjective image similarly revealed no differences with a good interobserver agreement (ICC = 0.647).

Conclusions

Catheter-directed CTA is safe and provides comparable image quality with a substantial retrenchment of the needed amount of iodine-based contrast medium. However, no benefit of the reduced contrast medium protocol with respect to renal function was observed.

Klíčová slova:

Biology and life sciences – Bioengineering – Biotechnology – Medical devices and equipment – Catheters – Anatomy – Renal system – Kidneys – Biochemistry – Biomarkers – Creatinine – Neuroscience – Neuroimaging – Engineering and technology – Medicine and health sciences – Cardiovascular anatomy – Blood vessels – Aorta – Vascular medicine – Vascular diseases – Aneurysms – Diagnostic medicine – Diagnostic radiology – Tomography – Computed axial tomography – Radiology and imaging – Nephrology – Chronic kidney disease – Research and analysis methods – Imaging techniques


Zdroje

1. Ashton HA, Buxton MJ, Day NE, Kim LG, Marteau TM, Scott RAP, Thompson SG, Walker NM (2002) The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet 360(9345):1531–1539 doi: 10.1016/s0140-6736(02)11522-4 12443589

2. Gianfagna F, Veronesi G, Bertù L, Tozzi M, Tarallo A, Ferrario MM, Castelli P (2016) Prevalence of abdominal aortic aneurysms and its relation with cardiovascular risk stratification: protocol of the Risk of Cardiovascular diseases and abdominal aortic Aneurysm in Varese (RoCAV) population based study. BMC Cardiovasc Disord 16(1):243. doi: 10.1186/s12872-016-0420-2 27894269

3. Kniemeyer HW, Kessler T, Reber PU, Ris HB, Hakki H, Widmer MK (2000) Treatment of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multi-organ-dysfunction score. Eur J Vasc Endovasc Surg 19(2):190–196. doi: 10.1053/ejvs.1999.0980 10727370

4. Wanhainen A, Verzini F, van Herzeele I et al (2019) Editor's Choice—European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 57(1):8–93. doi: 10.1016/j.ejvs.2018.09.020 30528142

5. Anderson PL, Arons RR, Moskowitz AJ, Gelijns A, Magnell C, Faries PL, Clair D, Nowygrod R, Kent KC (2004) A statewide experience with endovascular abdominal aortic aneurysm repair: rapid diffusion with excellent early results. J Vasc Surg 39(1):10–19. doi: 10.1016/j.jvs.2003.07.020 14718804

6. Powell JT, Sweeting MJ, Ulug P, Blankensteijn JD, Lederle FA, Becquemin J-P, Greenhalgh RM (2017) Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Br J Surg 104(3):166–178. doi: 10.1002/bjs.10430 28160528

7. Zettervall SL, Ultee KHJ, Soden PA, Deery SE, Shean KE, Pothof AB, Wyers M, Schermerhorn ML (2017) Predictors of renal dysfunction after endovascular and open repair of abdominal aortic aneurysms. J Vasc Surg 65(4):991–996. doi: 10.1016/j.jvs.2016.06.113 27687321

8. Dang T, Dakour-Aridi H, Rizwan M, Nejim B, Malas MB (2019) Predictors of acute kidney injury after infrarenal abdominal aortic aneurysm repair in octogenarians. J Vasc Surg 69(3):752–762.e1. doi: 10.1016/j.jvs.2018.05.227 30154014

9. Adas Z al Shepard AD, Nypaver TJ Weaver MR, Maatman T Yessayan LT, Balraj P Kabbani LS (2018) Long-term decline in renal function is more significant after endovascular repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 68(3):739–748. doi: 10.1016/j.jvs.2017.12.051 29571627

10. Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, Mastracci TM, Mell M, Murad MH, Nguyen LL, Oderich GS, Patel MS, Schermerhorn ML, Starnes BW (2018) The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg 67(1):2–77.e2. doi: 10.1016/j.jvs.2017.10.044 29268916

11. Faggioni M, Mehran R (2016) Preventing Contrast-induced Renal Failure: A Guide. Interventional Cardiology Review 11(2):98. doi: 10.15420/icr.2016:10:2 29588714

12. Isaacson AJ, Burke LMB, Vallabhaneni R, Farber MA (2016) Ultralow Iodine Dose Transarterial Catheter-Directed CT Angiography for Fenestrated Endovascular Aortic Repair Planning. Ann Vasc Surg 35:234–237. doi: 10.1016/j.avsg.2016.01.045 27238979

13. Garcarek J, Kurcz J, Guziński M, Banasik M, Miś M, Gołębiowski T (2015) Intraarterial CT Angiography Using Ultra Low Volume of Iodine Contrast—Own Experiences. Pol J Radiol 80:344–349. doi: 10.12659/PJR.894050 26191113

14. Formosa A, Santos DM, Marcuzzi D, Common AA, Prabhudesai V (2016) Low Contrast Dose Catheter-Directed CT Angiography (CCTA). Cardiovasc Intervent Radiol 39(4):606–610. doi: 10.1007/s00270-015-1232-y 26514834

15. Khalilzadeh O, Baerlocher MO, Shyn PB, Connolly BL, Devane AM, Morris CS, Cohen AM, Midia M, Thornton RH, Gross K, Caplin DM, Aeron G, Misra S, Patel NH, Walker TG, Martinez-Salazar G, Silberzweig JE, Nikolic B (2017) Proposal of a New Adverse Event Classification by the Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol 28(10):1432–1437.e3. doi: 10.1016/j.jvir.2017.06.019 28757285

16. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174 843571

17. Zhang B, Liang L, Chen W, Liang C, Zhang S (2015) The efficacy of sodium bicarbonate in preventing contrast-induced nephropathy in patients with pre-existing renal insufficiency: a meta-analysis. BMJ Open 5(3):e006989. doi: 10.1136/bmjopen-2014-006989 25783425

18. Subramaniam RM, Suarez-Cuervo C, Wilson RF, Turban S, Zhang A, Sherrod C, Aboagye J, Eng J, Choi MJ, Hutfless S, Bass EB (2016) Effectiveness of Prevention Strategies for Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis. Ann Intern Med 164(6):406–416. doi: 10.7326/M15-1456 26830221

19. Xu R, Tao A, Bai Y, Deng Y, Chen G (2016) Effectiveness of N-Acetylcysteine for the Prevention of Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc 5(9). doi: 10.1161/JAHA.116.003968 27663415

20. Weisbord SD, Gallagher M, Kaufman J, Cass A, Parikh CR, Chertow GM, Shunk KA, McCullough PA, Fine MJ, Mor MK, Lew RA, Huang GD, Conner TA, Brophy MT, Lee J, Soliva S, Palevsky PM (2013) Prevention of contrast-induced AKI: a review of published trials and the design of the prevention of serious adverse events following angiography (PRESERVE) trial. Clin J Am Soc Nephrol 8(9):1618–1631. doi: 10.2215/CJN.11161012 23660180

21. Weisbord SD, Gallagher M, Jneid H, Garcia S, Cass A, Thwin S-S, Conner TA, Chertow GM, Bhatt DL, Shunk K, Parikh CR, McFalls EO, Brophy M, Ferguson R, Wu H, Androsenko M, Myles J, Kaufman J, Palevsky PM (2018) Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. N Engl J Med 378(7):603–614. doi: 10.1056/NEJMoa1710933 29130810

22. Nakahashi H, Kosuge M, Sakamaki K, Kiyokuni M, Ebina T, Hibi K, Tsukahara K, Iwahashi N, Kuji S, Oba MS, Umemura S, Kimura K (2017) Combined impact of chronic kidney disease and contrast-induced nephropathy on long-term outcomes in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention. Heart Vessels 32(1):22–29. doi: 10.1007/s00380-016-0836-8 27106917

23. Giacoppo D, Madhavan MV, Baber U, Warren J, Bansilal S, Witzenbichler B, Dangas GD, Kirtane AJ, Xu K, Kornowski R, Brener SJ, Généreux P, Stone GW, Mehran R (2015) Impact of Contrast-Induced Acute Kidney Injury After Percutaneous Coronary Intervention on Short- and Long-Term Outcomes: Pooled Analysis From the HORIZONS-AMI and ACUITY Trials. Circ Cardiovasc Interv 8(8):e002475. doi: 10.1161/CIRCINTERVENTIONS.114.002475 26198286

24. Watabe H, Sato A, Hoshi T, Takeyasu N, Abe D, Akiyama D, Kakefuda Y, Nishina H, Noguchi Y, Aonuma K (2014) Association of contrast-induced acute kidney injury with long-term cardiovascular events in acute coronary syndrome patients with chronic kidney disease undergoing emergent percutaneous coronary intervention. Int J Cardiol 174(1):57–63. doi: 10.1016/j.ijcard.2014.03.146 24726211

25. Narula A, Mehran R, Weisz G, Dangas GD, Yu J, Généreux P, Nikolsky E, Brener SJ, Witzenbichler B, Guagliumi G, Clark AE, Fahy M, Xu K, Brodie BR, Stone GW (2014) Contrast-induced acute kidney injury after primary percutaneous coronary intervention: results from the HORIZONS-AMI substudy. Eur Heart J 35(23):1533–1540. doi: 10.1093/eurheartj/ehu063 24603308

26. Swanberg J, Nyman R, Magnusson A, Wanhainen A (2014) Selective intra-arterial dual-energy CT angiography (s-CTA) in lower extremity arterial occlusive disease. Eur J Vasc Endovasc Surg 48(3):325–329. doi: 10.1016/j.ejvs.2014.05.013 24958221

27. Zemedkun M, LaBounty TM, Bergman G, Wong S-C, Lin FY, Reynolds D, Gomez M, Dunning AM, Leipsic J, Min JK (2015) Effectiveness of a low contrast load CT angiography protocol in octogenarians and nonagenarians being evaluated for transcatheter aortic valve replacement. Clin Imaging 39(5):815–819. doi: 10.1016/j.clinimag.2014.08.010 25982494

28. McCullough PA (2008) Contrast-induced acute kidney injury. J Am Coll Cardiol 51(15):1419–1428. doi: 10.1016/j.jacc.2007.12.035 18402894

29. Gohbara M, Hayakawa A, Akazawa Y, Furihata S, Kondo A, Fukushima Y, Tomari S, Endo T, Kimura K, Tamura K (2017) Association Between Acidosis Soon After Reperfusion and Contrast-Induced Nephropathy in Patients With a First-Time ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 6(8). doi: 10.1161/JAHA.117.006380 28835362

30. Andò G, Morabito G, Gregorio C de, Trio O, Saporito F, Oreto G (2013) Age, glomerular filtration rate, ejection fraction, and the AGEF score predict contrast-induced nephropathy in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Catheter Cardiovasc Interv 82(6):878–885. doi: 10.1002/ccd.25023 23703775

31. McDonald JS, McDonald RJ, Comin J, Williamson EE, Katzberg RW, Murad MH, Kallmes DF (2013) Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. Radiology 267(1):119–128. doi: 10.1148/radiol.12121460 23319662

32. Ghumman SS, Weinerman J, Khan A, Cheema MS, Garcia M, Levin D, Suri R, Prasad A (2017) Contrast induced-acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media: A meta-analysis and systematic review of current literature. Catheter Cardiovasc Interv 90(3):437–448. doi: 10.1002/ccd.27051 28463460


Článek vyšel v časopise

PLOS One


2019 Číslo 9

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Výhody léčby pacientů s DM 2. typu GLP-1 agonisty
nový kurz
Autoři: prof. MUDr. Martin Haluzík, DrSc.

Syndrom suchého oka – diagnostika, komplikace a léčba
Autoři: MUDr. Petr Výborný, CSc., FEBO

Systémová léčba psoriázy
Autoři: MUDr. Jiří Horažďovský, Ph.D

Klinická farmakokinetika betablokátorů
Autoři:

Současné možnosti terapie osteoartrózy
Autoři: MUDr. Jakub Holešovský

Všechny kurzy
Kurzy Doporučená témata