Objectives
Patients with chronic kidney disease (CKD) who undergo peripheral vascular interventions (PVI) with iodinated contrast are at higher risk of postcontrast acute kidney injury (PC-AKI). CO2 angiography can reduce iodinated contrast volume usage in this patient population, but its impact on PC-AKI has not been studied. This article examines the use of CO2 angiography during PVI in the VQI. We hypothesize that CO2 angiography is associated with a decrease in PC-AKI in patients with advanced CKD.
Methods
The Vascular Quality Initiative PVI dataset from 2010 to 2021 was reviewed. Only patients with advanced CKD (estimated glomerular filtration rate of <45 mL/min/1.73 m2) treated for PAD were included. Propensity matching based on demographics, comorbidities, CKD stage, and indications were used to compare the outcomes of patients treated with and without CO2.
Results
There were 20,706 PVIs performed in patients with advanced CKD and only 22% utilized CO2 angiography. Patients who underwent CO2 angiography were younger and less likely to be women or white. However, they were more likely to have more advanced CKD stage, diabetes, and cardiac comorbidities, and be treated for tissue loss compared with patients treated without CO2. Propensity matching yielded 2 well-matched groups with 4396 patients each (Table I). The procedural details after matching demonstrated 50% reduction in the volume of contrast used (32.1 mL vs 63.4 mL; P < .001). PVI with CO2 angiography was associated with lower rates of PC-AKI (3.8% vs 5.1%; P = .01) and cardiac complications (2.1% vs 2.9%; P = .03) without a significant difference in technical failure rates or major/minor amputations (Table II).
Conclusions
CO2 angiography reduces contrast volume usage by 50% during PVI and is associated with decreased cardiac complications and PC-AKI. CO2 angiography is underutilized and should be considered for endovascular treatment of PAD in all patients with advanced CKD.
