Carbon dioxide versus iodine contrast medium for endovascular revascularization of aortoiliac occlusive disease: a two-center randomized controlled trial

Abstract

Objectives The objective of this study was to compare the quality of radiographic imaging obtained intraoperatively using carbon dioxide (CO2) as a contrast medium with iodinated contrast media in patients undergoing endovascular revascularization of aortoiliac occlusive disease Trans-Atlantic Inter-Society Consensus A, B, and C in patients without renal impairment. Patients and methods Recruitment started from July 2015 and ended July 2018. Patients with aortoiliac occlusive disease who were eligible for endovascular treatment and lacked contraindications to either iodine contrast or CO2 were offered to participate. After informed consent, they were randomized into the CO2 arm (32) patients or iodine contrast medium (ICM) arm (32) patients. They underwent aortoiliac angioplasty blinded to the type of contrast type used. The primary outcome was the quality of image using one type of contrast agent to perform the needed interventions. The secondary outcomes were technical success rate and the safety of procedure. Imaging from all cases were analyzed within 12 weeks of conclusion of the study by two independent observers blinded to treatment arm. Results CO2 angiography images were classified as very good in 27.4% (25.8 and 29%), whereas 39% (40.6 and 37.5%) of iodine arteriograms were classified as very good by two observers, with no statistical significance (P=0.158 and 0.176). Interoperator agreement analysis showed substantial agreement (kappa=0.712). Technical success was 100%, with no procedure-related deaths. The treatment time was longer when CO2 was used as contrast medium (87±22\u2009min) versus using ICM (77±28\u2009min). The use of ICM was required in three (9%) CO2 patients to complete the procedure. Conclusion Using CO2 as a contrast medium in aortoiliac arterial occlusive disease in normal kidney function patients produces good-quality images and is practical and safe. It is a comparable alternative to ICM with minimum risk of affecting kidney function and complications.