PURPOSE: To evaluate the feasibility of targeted renal therapy (TRT) to decrease the rate of contrast-induced nephropathy (CIN) during endovascular aortic aneurysm repair (EVAR) in patients at risk for CIN. METHODS: A prospective nonrandomized analysis of TRT was performed in 10 high-risk patients (8 men; median age 66.5 years, range 56-80) with pre-existing renal insufficiency. TRT involved high-dose intrarenal artery infusions of fenoldopam (FEN), a short acting selective dopamine-1 agonist and renal arteriolar vasodilator, delivered percutaneously via a left brachial access using the 5-F Benephit PV Infusion System during EVAR. RESULTS: There were no device-related complications. TRT infusion duration ranged from 3.5 to 6.0 hours (median 4.5). Median contrast dosage was 120 mL (range 50-200). At 24 and 72 hours after EVAR, creatinine clearance (CrCl) had improved in 7 (70%) patients, remained unchanged in 2 (20%), and declined >25% in 1 (10%); the latter returned to baseline on day 5. At 30 days, 7 (70%) patients had improved CrCl and 3 (30%) remained unchanged. CONCLUSION: TRT is feasible during EVAR in high-risk patients. Further investigation is warranted to determine the safety and efficacy of TRT in preserving renal function during EVAR.
PURPOSE: To evaluate the feasibility of targeted renal therapy (TRT) to decrease the rate of contrast-induced nephropathy (CIN) during endovascular aortic aneurysm repair (EVAR) in patients at risk for CIN. METHODS: A prospective nonrandomized analysis of TRT was performed in 10 high-risk patients (8 men; median age 66.5 years, range 56-80) with pre-existing renal insufficiency. TRT involved high-dose intrarenal artery infusions of fenoldopam (FEN), a short acting selective dopamine-1 agonist and renal arteriolar vasodilator, delivered percutaneously via a left brachial access using the 5-F Benephit PV Infusion System during EVAR. RESULTS: There were no device-related complications. TRT infusion duration ranged from 3.5 to 6.0 hours (median 4.5). Median contrast dosage was 120 mL (range 50-200). At 24 and 72 hours after EVAR, creatinine clearance (CrCl) had improved in 7 (70%) patients, remained unchanged in 2 (20%), and declined >25% in 1 (10%); the latter returned to baseline on day 5. At 30 days, 7 (70%) patients had improved CrCl and 3 (30%) remained unchanged. CONCLUSION: TRT is feasible during EVAR in high-risk patients. Further investigation is warranted to determine the safety and efficacy of TRT in preserving renal function during EVAR.
Authors: Athanasios Saratzis; Michael F Bath; Seamus Harrison; Robert D Sayers; Asif Mahmood; Pantelis Sarafidis; Matthew J Bown Journal: Clin J Am Soc Nephrol Date: 2015-10-20 Impact factor: 8.237
Authors: Horng H Chen; Alessandro Cataliotti; John A Schirger; Fernando L Martin; Lynn K Harstad; John C Burnett Journal: J Am Coll Cardiol Date: 2009-04-14 Impact factor: 24.094
Authors: Christopher Hudson; Jordan Hudson; Madhav Swaminathan; Andrew Shaw; Mark Stafford-Smith; Uptal D Patel Journal: Semin Cardiothorac Vasc Anesth Date: 2008-11-19
Authors: Pantelis Sarafidis; Sven Martens; Athanasios Saratzis; Daniella Kadian-Dodov; Patrick T Murray; Catherine M Shanahan; Allen D Hamdan; Daniel T Engelman; Ulf Teichgräber; Charles A Herzog; Michael Cheung; Michel Jadoul; Wolfgang C Winkelmayer; Holger Reinecke; Kirsten Johansen Journal: Cardiovasc Res Date: 2022-09-20 Impact factor: 13.081