Zero-Contrast EVAR Can Be Reached Using Automated Carbon Dioxide Digital Angiography, Endoaortic Balloon Occlusion,
Manuel Miralles1,2,3, Francesca Maria Mursia1, Luis García Domínguez1
1Angiology and Vascular Surgery Service, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Innovations (Philadelphia, Pa.)
|August 7, 2026
Summary
This study introduces a new method for CO2-assisted EVAR, significantly reducing iodinated contrast and radiation exposure. The combined use of balloon occlusion and IVUS achieved "zero contrast" in most patients, enhancing safety.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Interventional Radiology
Background:
- Endovascular aneurysm repair (EVAR) traditionally relies on iodinated contrast (IC) and radiation, posing risks to patients.
- Carbon dioxide (CO2) angiography offers an alternative to reduce IC, but visualization can be challenging.
- Enhancing CO2 visualization and graft deployment accuracy is crucial for improving EVAR outcomes.
Purpose of the Study:
- To present a novel technique combining CO2 angiography (CO2Angio) with endovascular balloon occlusion and intravascular ultrasound (IVUS) to improve EVAR.
- To assess the efficacy of this combined approach in reducing IC and radiation exposure.
- To enhance the visualization of renal arteries and accuracy of graft deployment in CO2-assisted EVAR.
Main Methods:
- A retrospective observational study of consecutive CO2-assisted EVAR cases.
- Patients were grouped based on the progressive introduction of CO2Angio, CO2Angio with EVclamp (balloon occlusion), and CO2Angio + EVclamp + IVUS.
- Data collected included IC volume, CO2 volume, radiation dose, fluoroscopy time, and procedural outcomes.
Main Results:
- The group using CO2Angio + EVclamp + IVUS showed significant reductions in total radiation (air kerma) and dose area product.
- A substantial decrease in IC volume was observed, achieving "zero contrast" in the last 12 patients.
- No significant differences were noted in fluoroscopy time, operative time, CO2 volume, or renal function.
Conclusions:
- The integration of endoluminal balloon occlusion and IVUS with CO2-assisted EVAR is effective.
- This combined approach successfully achieved the goal of zero contrast and reduced radiation doses.
- The method enhances visualization and accuracy in EVAR, offering a safer alternative to traditional contrast agents.
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