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Comparative Study
. 2019 Sep 10;14(9):e0221375.
doi: 10.1371/journal.pone.0221375. eCollection 2019.

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

Marco V Usai  1 , Mirjam Gerwing  2 , Antje Gottschalk  3 , Peter Sporns  2 , Walter Heindel  2 , Alexander Oberhuber  1 , Moritz Wildgruber  2 , Michael Köhler  2
Affiliations
Comparative Study

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

Marco V Usai et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Creatinine levels in the course of CTA at baseline (B), 1–7 days post CT imaging (I), preoperatively before endovascular aortic aneurysm repair (P) and at late follow-up (F).
Dotted line marks border towards elevated creatine levels beyond the reference values of 1.4 mg/dl.
Fig 2
Fig 2
Representative CTA images of a catheter-directed CTA (coronal maximum intensity projection in A, transversal image after i.a. contrast application in B), and in comparison of an intravenous CTA (coronal maximum intensity projection in C, transversal image after i.v. contrast application in D).
See this image and copyright information in PMC

References

    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 10.1016/s0140-6736(02)11522-4 - DOI - PubMed
    1. 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 10.1186/s12872-016-0420-2 - DOI - PMC - PubMed
    1. 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. 10.1053/ejvs.1999.0980 - DOI - PubMed
    1. 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. 10.1016/j.ejvs.2018.09.020 - DOI - PubMed
    1. 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. 10.1016/j.jvs.2003.07.020 - DOI - PubMed

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