AA1. Contrast Medium-Free Approach to Patients With Abdominal Aortic Disease and Renal Insufficiency

Diagnosis and endovascular treatment of abdominal aortic diseases could expose patients to worsening of renal function because of the use of iodinated contrast medium. We report a specific contrast medium-free approach to patients with abdominal aortic disease and moderate to severe renal insufficiency. The protocol includes accurate assessment of chronic kidney disease (CKD), preoperative ultrasound evaluation, intravascular ultrasound, and AFX2 endoprosthesis (Endologix, Irvine, Calif). From November 2017 to May 2018, there were 20 consecutive patients with abdominal aortic disease suitable for endovascular aneurysm repair (EVAR) who were treated (14 abdominal aortic aneurysms and 6 penetrating aortic ulcers). All patients underwent a preoperative ultrasound examination of the aorta and iliac and femoral arteries and tests to evaluate kidney function. Patients were divided into two groups. Eight patients presenting with moderate to severe CKD (glomerular filtration rate ≤40 mL/min/1.73 m2) were evaluated with thin-slice computed tomography scan without contrast medium and intraoperative intravascular ultrasound. This group was compared with 12 patients with normal renal function in whom a standard evaluation with preoperative computed tomography angiography was performed. Angiography was used only to check the level of the lower renal artery and to verify endoleaks, with a total injection of 16 mL of contrast medium in cases of very short neck. All patients underwent EVAR using AFX2 stent graft under local anesthesia. All EVAR procedures were completed successfully percutaneously in 19 of 20 patients; one open access was needed because of hostile femoral bifurcation. No contrast medium was used in patients with moderate to severe CKD. No renal artery-related complications or worsening of renal function was recorded perioperatively, and no renal arteries were covered. Our promising experience suggests that a contrast medium-free approach is a safe and valid option for patients with abdominal aortic diseases and moderate to severe CKD.