Preliminary Experience of Protocol for Digital Subtraction Angiography Using Diluted Contrast Medium during
Ayaka Yu1, Naoki Fujimura2, Kyosuke Hosokawa1
1Department of Vascular Surgery, Tokyo Saiseikai Central Hospital, Minato-ku, Tokyo, Japan.
Background:
This study aimed to evaluate the efficacy of digital subtraction angiography (DSA) using low-concentration contrast medium (LC-DSA) during endovascular aneurysm repair (EVAR).
Methods:
An LC-DSA protocol for EVAR using the Infinix Celeve-i angiography system (Canon Medical Systems Corporation, Tochigi, Japan) was developed through an ex vivo experiment. Seventeen patients undergoing EVAR using the LC-DSA protocol between October 2018 and November 2019 were prospectively analyzed. A historical cohort that underwent EVAR using a normal contrast medium between November 2017 and May 2018 was included as the control group (n = 11).
Results:
Contrast medium use was significantly lower in the LC-DSA group (15.8 mL vs. 64.6 mL, P < 0.001). There were no significant differences between the groups in clinical outcomes, including technical success (P = 0.44) and perioperative complications (P = 0.35). However, the quality of the DSA image was significantly inferior in the LC-DSA group (contrast noise ratio; 35.2 vs. 53.8, P = 0.01), and the radiation dose was significantly higher in the LC-DSA group (1290.0 mGy vs. 393.7 mGy, P < 0.001).
Conclusion:
The LC-DSA protocol for EVAR can reduce the amount of contrast medium used without affecting the clinical outcomes. However, this is associated with inferior image quality and a significant increase in radiation exposure, warranting further improvements.
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