Role of CO2 angioplasty as a safe option in endovascular treatment of peripheral arterial disease in high-risk patients using dedicated automated OptiMed CO2 delivery system

Abstract

Aim: The aim of this study was to emphasize the role of CO2 angioplasty using dedicated automatic OptiMed CO2 delivery system in patients with peripheral arterial disease (PAD) of high-risk group. Iodinated contrast media is harmful in all these patients of renal insufficiency with baseline creatinine >1.5 mg/dl. Methods: The present study is a retrospective analysis from a prospectively collected institutional review board-approved database. From April 2015 to June 2019, 44 patients (29 male patients and 15 female patients with a mean age of 68.5 years) underwent peripheral angioplasty using dedicated CO2 delivery system (OptiMed). All the patients were known diabetic with renal insufficiency due to chronic kidney disease (CKD). Demographic factors, clinical characteristics, and atherosclerotic risk factors were documented. Lesions included proximal and distal superficial femoral artery, popliteal, and below-the-knee vessels. Patients with chronic obstructive pulmonary disease, ventricular septal defects, and pulmonary vascular malformations were excluded from the study. Preliminary diagnosis by duplex scan was done in all the patients. Technical success, periprocedural events, and clinical outcomes were documented in all the patients. Results: Technical success was achieved in 43 cases (97.7%) which is described as successful balloon angioplasty resulting in increased vascularity of the distal limb due to improved distal runoff. Adequate imaging and successful intervention was achieved using OptiMed CO2 delivery system in majority of our patients. In one patient, the lesion could not be crossed and the patient had acute ST-elevation changes in electrocardiogram, and hence, the procedure was abandoned and the patient was shifted to cardiac care unit. Twenty-one patients complained of moderate pain which subsided with intra-arterial lidocaine. Four patients who complained of severe pain were given nerve block and sedation. There were no other intra- and postprocedural adverse events with stable renal parameters monitored up to 48 h. None of the patients required amputation after angioplasty in our study. Conclusion: With increasing burden of PAD in diabetic group, especially in CKD patients, angioplasty with dedicated CO2 delivery system is safe and effective with satisfactory outcome and should be considered as standard choice in this group of patients for limb salvage.

Keywords

• automated delivery
• co2 angioplasty
• contrast-induced nephropathy