Application of Noncontrast CT-Derived Volume Rendering Imaging and IVUS in Zero-Contrast EVAR: A Novel Technique

Abstract

Background:

Endovascular aneurysm repair (EVAR) is a minimally invasive treatment for abdominal aortic aneurysms. However, it poses challenges in chronic kidney disease (CKD) patients due to contrast-induced nephropathy (CIN). This case report presents a zero-contrast EVAR technique using noncontrast CT-derived volume rendering (VR) imaging and intravascular ultrasound (IVUS).

Case Presentation:

An 80-year-old male with CKD G4 underwent zero-contrast EVAR. Preoperative noncontrast CT-generated VR images were utilized for both surgical planning and intraoperative 3D roadmap, while intraoperative IVUS was used to identify key vascular landmarks, such as the renal arteries and internal iliac arteries bifurcation. This combination enabled precise vascular mapping and device placement without contrast agents. Preoperatively, renal function was serum creatinine (Cr) 2.64 mg/dL and estimated glomerular filtration rate (eGFR) 19.0 mL/min/1.73 m², indicating a high risk of CIN. At 6-month follow-up, postoperative evaluation confirmed stable renal function (Cr 2.82 mg/dL, eGFR 17.7 mL/min/1.73 m²) with no evidence of endoleaks.

Discussion:

This case demonstrates the feasibility of zero-contrast EVAR using VR imaging and IVUS, mitigating CIN risks while maintaining accuracy. VR imaging enhanced intraoperative navigation with detailed visualization and color mapping of critical branches. IVUS complemented VR imaging by providing real-time spatial relationships.

Conclusion:

The combination of VR imaging and IVUS offers a viable alternative for zero-contrast EVAR, particularly in patients contraindicated for contrast agents. This renal-sparing technique expands EVAR options for high-risk populations.

Clinical Impact

This case presents a novel approach to zero-contrast endovascular aneurysm repair (EVAR) by combining non-contrast CT-derived volume rendering (VR) imaging and intravascular ultrasound (IVUS). This technique provides a renal-sparing solution for patients with chronic kidney disease (CKD) at high risk of contrast-induced nephropathy (CIN). By enabling accurate vascular mapping and device placement without contrast agents, procedural safety is enhanced. The innovation lies in integrating VR for visualization and IVUS for real-time intraluminal assessment, ensuring precision while avoiding contrast-related risks. This method may expand EVAR options and improve outcomes in CKD patients unsuitable for traditional contrast-based imaging.