Tam Tıkalı Ana İliak Arterin; İonize Kontrast Madde Kullanmaksızın CO2’i Kontrast Ajan Olarak Kullanarak Endovasküler Yöntemle Tedavisi

Yıl 2017, Cilt: 12 Sayı: 2, 28 - 30, 26.09.2017

Mahmut Tuna Katırcıbaşı , Uğur Özkan

https://doi.org/10.17517/ksutfd.314305

Öz

Periferik arter hastaları arasında; kronik böbrek hastalığı yaygın olarak görülür. Güncel kılavuzlar bu hastalarda endovasküler tedavi yöntemlerini ilk tedavi seçeneği olarak önermektedir. Kontrastın indüklediği nefropati önceden kronik renal hastalığı, kalp yetersziliği olan veya işlem öncesi dehidrate kalan hastalarda oldukça yaygın olarak görünür ve bu durum hastanede yatış süresini ve mortaliteyi artırmaktadır. Bu tür hastalarda CO2 alternatif bir contrast ajan olarak kullanılabilir ve diğer gazlardan farklı olarak hemen hemen tamamı hızlı bir şekilde absorbe edilir. Bu vaka bildirisinde kronik böbrek hastalığı (glomerular filtration rate of 24 ml/min/1.77 m²) olan sol ana iliak arteri tam tıkalı bir hastada; contrast ajan olarak CO₂ in kullanıldığı bir vaka bildirilmiştir.

Anahtar Kelimeler

CO₂, kontrast ajan

Endovascular Treatment of Totally Occluded Main Iliac Artery Using CO2 without Iodinated Contrast Medium

Öz

Chronic kidney disease is a common comorbidity in
patients with peripheral artery disease (PAD). Current guidelines recommend an
“endovascular first” strategy in cases where for revascularization is indicated
Contrast-induced nephropathy (CIN) is a particularly common complication in
patients with pre-existing chronic renal disease, diabetes, heart failure, and
dehydration which is associated with increased time in hospital and long-term
mortality Carbon dioxide (CO2) gas can be used as an alternative contrast
agent, as it is absorbed almost instantaneously as opposed to other gases. In
this report, we describe a case of percutaneous transluminal angioplasty of an
occluded left main iliac artery using CO₂ as contrast medium
due to the presence of severe chronic kidney disease (glomerular filtration
rate of 24 ml/min/1.77 m²).

Anahtar Kelimeler

CO₂, contrast medium

Kaynakça

• 1. Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011; 32: 2851-2906
• 2. Katsiki N, Athyros VG, Karagiannis A, Mikhailidis DP. Contrastinduced Nephropathy: An ‘‘All or None’’ Phenomenon? Angiology. 2014; 66: 508-513.
• 3. Maioli M, Toso A, Leoncini M, Gallopin M, Musilli N, Bellandi F. Persistent renal damage after contrast-induced acute kidney injury: incidence, evolution, risk factors, and prognosis. Circulation. 2012; 125: 3099-3107.
• 4. Moos JM, Ham SW, Han SM, Lew WK, Hua HT, Hood DB et al. Safety of carbon dioxide digital subtraction angiography. Arch Surg. 2011; 146: 1428-1432.
• 5. Beese RC, Bees NR, Belli AM. Renal angiography using carbon dioxide. Br J Radiol. 2000 Jan. 73(865):3-6.
• 6. Moresco KP, Patel N, Johnson MS, Trobridge D, Bergan KA, Lalka SG. Accurac of CO2 angiography in vessel diameter assessment: a comparative study of CO2 versus iodinated contrast material in an aortoiliac flow model. J Vasc Interv Radiol. 2000; 11: 437-444.
• 7. Diaz LP, Pabon IP, Garcia JA, de la Cal Lopez MA. Assessment of CO2 arteriography in arterial occlusive disease of the lower extremities. J Vasc Interv Radiol. 2000; 11: 163-169.