ALİ CAM, MURAT CANYİĞİT, METE HIDIROĞLU, EROL ŞENER, HALİL ARSLAN, ALPASLAN ALTUNOĞLU
Cardiovascular Surgery and Interventions - 2020;7(3):143-151
Objectives: In this study, we aimed to evaluate the accuracy of transarterial computed tomography angiography (TA-CTA) in treatment planning and follow-up and to identify the contrast-induced nephropathy (CIN) risk of this procedure in patients with chronic kidney disease (CKD). Patients and methods: Between November 2012 and November 2013, a total of 14 patients (13 males, 1 female; mean age 73.8±7.2 years; range, 58 to 90 years) with CKD and an aortic aneurysm who underwent TA-CTA were included in this study. A flush catheter was placed in the aorta and CTA images were obtained by 64-slice multidetector computed tomography (MDCT). For the thoracoabdominal TA-CTA, a mixture of 16 mL contrast + 84 mL saline was used, while for the abdominal TA-CTA, 8 mL of contrast + 42 mL of saline mixture was used. These mixtures were injected with an automatic injector without delay in time. The image quality scores (IQS) were between 1 and 4. Serum creatinine and estimated glomerular filtration rate (eGFR) values were obtained before the procedure, and on Days 2-5 and at Months 1-3 after the procedure. Results: None of the patients developed CIN. The mean creatinine levels were as follows: 2.35 mg/dL before the procedure, 2.27 mg/dL on Days 2-5, and 2.28 mg/dL at Months 1-3 (p=0.084 and 0.109, respectively). The mean eGFR values were as follows: 32.2 mL/min/1.73 m2 before the procedure, 34.2 mL/min/1.73 m2 on Days 2-5, and 34.6 mL/min/1.73 m2 at Months 1-3 (p=0.061 and 0.017, respectively). The Hounsfield unit (HU) values were as follows: 184 to 251 HU (mean: 230 HU) on the distal ascending aorta, 104 to 430 HU (mean: 198 HU) on the renal artery level of the abdominal aorta, 104 to 430 HU (mean: 198 HU) at the terminal aorta, 88 to 406 HU (mean: 183 HU) on the common iliac arteries, and 103 to 274 HU (mean: 171 HU) on the common femoral arteries The HU value was measured in a non-enhanced area as 22 to 45 HU (mean: 32 HU). The mean IQS of Observer 1 and Observer 2 was 3.52 and 3.47, respectively. Only one TA-CTA procedure was scored differently. The mean IQS was 3.495 with an intra-observer agreement of 94%. Conclusion: Despite its invasive nature, diluted, low-contrast enhanced TA-CTA is an easy-to-use and safe method which provides sufficient anatomical details without causing any nephropathy risk.
