Abstract
Objective
Contrast-induced nephropathy remains a significant concern in patients undergoing endovascular aneurysm repair (EVAR), particularly those with pre-existing renal impairment. This study aimed to evaluate the feasibility and safety of using a one-quarter diluted contrast agent during EVAR to reduce contrast volume without compromising imaging quality or clinical outcomes.
Methods
We retrospectively reviewed EVAR procedures performed between July 2022 and September 2024. A total of 96 patients were included, with 50 receiving undiluted contrast and 46 receiving a one-quarter diluted solution. All procedures were conducted using the same angiographic system and protocol. Pixel values and signal-to-noise ratios (SNRs) were measured from digital subtraction angiography (DSA) images. Subjective image quality was independently evaluated by three vascular surgeons using a standardized 5-point scale. Postoperative type I/III endoleaks were identified on contrast-enhanced CT or ultrasound within 30 days. Statistical comparisons were performed using Welch’s t-test, Mann–Whitney U test, chi-square test, or Fisher’s exact test, as appropriate.
Results
Procedural success was achieved in all cases. The diluted group achieved a 70% reduction in contrast volume (19.8 ± 11.5 mL vs 67.7 ± 30.5 mL; P < .001). Pixel values (2.87 ± 8.75 vs 2.99 ± 5.59; P = .936), SNRs, and surgeon-rated image quality were comparable between groups. The incidence of type I/III endoleaks (2.0% vs 4.3%; P = .606) and radiation parameters did not differ significantly.
Conclusions
Use of a one-quarter diluted contrast agent during EVAR provided image quality and safety comparable to undiluted contrast while significantly reducing contrast volume. This technique may represent a practical strategy to mitigate renal risk in patients with impaired kidney function.
Keywords
Get full access to this article
View all access options for this article.