Computerized tomography angiography by direct intra-aortic low volume contrast injection in patients being evaluated for EVAR

Abstract

Background

Computerized tomography angiography is an important tool for endovascular repair of abdominal aortic aneurysm planning. This study aimed to evaluate the utility of computerized tomography angiography using direct intra-aortic injection of low volume of iodinated contrast in patients being considered for endovascular repair of abdominal aortic aneurysm.

Design

A 5F high-flow angiographic catheter was positioned in the mid-thoracic aorta through femoral percutaneous access. Computerized tomography angiography was performed with image acquisition starting simultaneously with power injection of 10 mL of iopamidol 76% diluted with normal saline to 50 mL, at 6 mL/s through the angiographic catheter. Aortic enhancement was assessed with a circular region-of-interest within the aorta. Values ≥150 HU were considered adequate.

Results

Nine patients with abdominal aortic aneurysm and chronic renal dysfunction underwent computerized tomography angiography with intra-arterial contrast injection for endovascular repair of abdominal aortic aneurysm planning. Mean age 78.8 ± 5.0 years, mean baseline creatinine 1.8 ± 0.4 mg/dL and mean glomerular filtration rate 36.8 ± 4.2 mL/min. Adequate computerized tomography angiography aortic enhancement was obtained in all cases (mean intra-aortic density: 300.4 ± 72.8 HU). The total contrast volume used for the computerized tomography angiography and the endovascular repair of abdominal aortic aneurysm combined was 30.0 ± 21.4 mL. Seventy-five percent of the patients received ≤30 mL of contrast. No significant renal function deterioration occurred (creatinine clearance pre- and post-procedure 36.8 ± 4.2 mL/min versus 38.6 ± 6.1 mL/min, p = 0.32). Successful endovascular repair of abdominal aortic aneurysm was achieved in eight patients. One patient underwent open treatment based on computerized tomography angiography information. No endoleak or aneurysm growth occurred (median follow-up: 121 days (range 36–1242)).

Conclusion

Direct intra-aortic injection of low volume of iodinated contrast provides adequate and reproducible pattern of aortic enhancement on computerized tomography angiography. The computerized tomography angiography so acquired can be used for endovascular repair of abdominal aortic aneurysm limiting the total volume of iodinated contrast required.

Keywords

Computed tomography angiogram intra-arterial contrast injection endovascular aortic repair abdominal aortic aneurysm renal dysfunction renal failure

Get full access to this article

View all access options for this article.

References

Nietlispach

Leipsic

Al-Bugami

et al.

CT of the ilio-femoral arteries using direct aortic contrast injection: proof of feasibility in patients screened towards percutaneous aortic valve replacement. Swiss Med Wkly 2009; 139: 458–462.

Joshi

Mendoza

Steinberg

et al.

Ultra-low-dose intra-arterial contrast injection for iliofemoral computed tomographic angiography. JACC Cardiovasc Imaging 2010; 2: 1404–1411.

Nijhof

van der Vos

Anninga

et al.

Reduction of contrast medium volume in abdominal aorta CTA: multiphasic injection technique versus a test bolus volume. Eur J Radiol 2013; 82: 1373–1378.

Sigal-Cinqualbre

Hennequin

Abada

et al.

Low-kilovoltage multi-detector row chest CT in adults: feasibility and effect on image quality and iodine dose. Radiology 2004; 231: 169–174.

LaBounty

Leipsic

Poulter

et al.

Coronary CT angiography of patients with a normal body mass index using 80 kVp versus 100 kVp: a prospective, multicenter, multivendor randomized trial. AJR Am J Roentgenol 2011; 197: W860–W867.

Marin

Nelson

Schindera

et al.

Low-tube-voltage, high-tube-current multidetector abdominal CT: improved image quality and decreased radiation dose with adaptive statistical iterative reconstruction algorithm – initial clinical experience. Radiology 2010; 254: 145–153.

Formosa

Santos

Marcuzzi

et al.

Low contrast dose catheter-directed CT angiography (CCTA). Cardiovasc Intervent Radiol 2015; 39: 606–610.

Moos

Ham

Han

et al.

Safety of carbon dioxide digital subtraction angiography. Arch Surg 2011; 146: 1428–1432.

Gahlen

Hansmann

Schumacher

et al.

Carbon dioxide angiography for endovascular grafting in high-risk patients with infrarenal abdominal aortic aneurysms. J Vasc Surg 2001; 33: 646–649.

10.

Chao

Major

Kumar

et al.

Carbon dioxide digital subtraction angiography-assisted endovascular aortic aneurysm repair in the azotemic patient. J Vasc Surg 2007; 45: 451–458; discussion 458–460.

11.

Criado

Upchurch

Young

et al.

Endovascular aortic aneurysm repair with carbon dioxide-guided angiography in patients with renal insufficiency. J Vasc Surg 2012; 55: 1570–1575.

12.

Huang

Woo

Moos

et al.

A prospective study of carbon dioxide digital subtraction versus standard contrast arteriography in the detection of endoleaks in endovascular abdominal aortic aneurysm repairs. Ann Vasc Surg 2012; 27: 38–44.

13.

Sueyoshi

Nagayama

Sakamoto

et al.

Carbon dioxide digital subtraction angiography as an option for detection of endoleaks in endovascular abdominal aortic aneurysm repair procedure. J Vasc Surg 2014; 61: 298–303.

14.

Stacul

van der Molen

Reimer

et al.

Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 2011; 21: 2527–2541.

15.

Kooiman

Le Haen

Gezgin

et al.

Contrast-induced acute kidney injury and clinical outcomes after intra-arterial and intravenous contrast administration: risk comparison adjusted for patient characteristics by design. Am Heart J 2013; 165: 793–799.

16.

Nyman

Almén

Jacobsson

et al.

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

Eur Radiol 2012; 22: 1366–1371.

17.

Han

Patel

Rowe

et al.

Ultrasound-determined diameter measurements are more accurate than axial computed tomography after endovascular aortic aneurysm repair. J Vasc Surg 2010; 51: 1381–1387. discussion 1387–1389.