Endovascular Abdominal Aortic Aneurysm Repair Using Transvenous Intravascular US Catheter Guidance in Patients with Chronic Renal Failure

Abstract Purpose To describe the transvenous application of intracardiac echocardiography (ICE) for guidance during endovascular aortic repair (EVAR). Materials and Methods Eight patients with an infrarenal abdominal aortic aneurysm (AAA) and chronic renal failure were determined suitable for EVAR. The procedure was performed by deploying the transcaval and transiliac vein guidance of an ICE catheter to reduce the dosage of iodinated contrast medium. Multiple guidance parameters were assessed. The present study describes the EVAR procedure and postprocedure transabdominal ultrasound (US) follow-up results at 3–4 months. Results The eight procedures were completed by using transvenous ICE guidance. No contrast medium was used in five patients, and 3–20 mL of isoosmolar contrast medium was administered in the other three. No endoleaks were detected by ICE immediately after stent deployment. One patient who had a single functioning kidney developed renal failure that was attributed to manipulation-related cholesterol embolization. That patient became dependent on dialysis and died 3.5 months after the procedure. No endoleaks were detected at 3–4-month US follow-up in the other seven patients. Conclusions Transvenous ICE guidance is a promising method to reduce the dosage of iodinated contrast medium in patients with renal dysfunction undergoing EVAR. A prospective trial comparing this modality versus digital subtraction angiography guidance with iodinated contrast medium in terms of safety, accuracy, and long-term efficacy is recommended.