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COデジタルサブトラクション血管造影と術中造影超音波検査を用いた血管内動脈瘤修復術。シングルセンターでの経験
Endovascular aneurysm repair assisted by CO digital subtraction angiography and intra-operative contrast-enhanced ultrasonography: Single centre experience.
PMID: 32599109 DOI: 10.1016/j.avsg.2020.06.036.
抄録
背景:
ヨウ素化造影剤（IC）に対するアレルギーと進行した慢性腎臓病（CKD）は腹部大動脈瘤（EVAR）の血管内修復術の大きな制約となっている。我々は、造影剤によるアレルギーやネフローゼを回避するために、術中造影超音波検査（CEUS）とCOアシストEVARを併用した経験を述べている。
BACKGROUND: Allergy to iodinated contrast (IC) agent and advanced chronic kidney disease (CKD) are major limitations to endovascular repair of abdominal aortic aneurysms (EVAR). We describe our experience combining CO assisted EVAR with intraoperative contrast-enhanced ultrasound (CEUS) in an attempt to avoid contrast induced allergy or nephropathy.
方法:
単一施設でCO補助EVARを受けた患者のデータをプロスペクティブに取得した観察的コホート研究。IC禁忌患者を対象にコンピュータ断層撮影または磁気共鳴大動脈造影を用いてEVAR計画を行った。患者はeGFRが40mL/min以下で、解剖学的に従来の胸膜下EVARに適している場合に検討された。アウトカムには、技術的成功率、再介入率、総放射線量、入院期間、グラフトのキンクや移行などが含まれていた。
METHODS: Observational cohort study using prospectively acquired data on patients undergoing CO-assisted EVAR in single institution. EVAR planning was performed using computed tomographic angiography or magnetic resonance aortography in patients contraindicated for IC. Patients were considered if their eGFR <40mL/min and anatomically suitable for conventional infrarenal EVAR. Outcomes of interest included technical success rate and re-intervention rates, total radiation dose, length of hospital stay and graft kinking or migration.
結果:
RESULTS: Fifteen patients (10 male) were treated across a 5-year period. Technical success was achieved in all cases. Completely iodinated contrast free EVAR was performed in 9 cases, whilst the remaining 6 required IC administration for adjunct procedures. CO completion angiography detected all type I endoleaks (2 Ia & 1 Ib) but was less sensitive to type II. Intraoperative CEUS confirmed all type I and 2 cases of type II endoleaks. Median hospital stay was 4 days. No significant deterioration in renal function was seen post-operatively.
結論:
腹部大動脈瘤を有し、IC禁忌の患者において、COデジタルサブトラクション血管造影とCEUSを併用することで、安全かつ効率的にIC治療薬の必要性を最小限に抑え、中期的には満足のいく結果を得ることができる。
CONCLUSIONS: In patients with abdominal aortic aneurysms and with contraindication for IC, a combined approach of using CO digital subtraction angiography and CEUS can be used safely and efficiently to minimize or obviate the need for IC agents with satisfactory mid-term results.
Copyright © 2020 Elsevier Inc. All rights reserved.