Ismazizi Zaharuddin
Current Position
Consultant Vascular/ Endovascular Surgeon & Chief in Vascular/ Endovascular Division
Dept of Cardiothoracic & Vascular Surgery, National Heart Institute ( Institut Jantung Negara ), Kuala Lumpur, Malaysia
Abdominal Aorta & Aortic iliac Session

Topic: CERAB with CO2 angiogram in pt with aorto-Iliac disease and CKD: national heart institute experience


The risk of contrast induced acute kidney injury is an important factor that influence treatment decisions in patients with both Aorto-Iliac Occlusive Disease (AOID) and pre-existing Chronic Kidney Disease (CKD), who undergo revascularization. It is one of the frequent complications of most endovascular procedures including Covered Reconstruction Aortic Bifurcation (CERAB) procedure for patients with AOID commonly caused by the known nephrotoxicity when using iodine-contrast medium (ICM). Although most patients recover to their pre-existing level, some may progress to more advanced stages of chronic kidney disease (CKD) which is associated with lower long-term survival. Despite the high prevalence of AOID in CKD patients, these high-risk patients undergo fewer revascularization procedures as compared to patients without CKD due to this limited option available. The use of carbon dioxide (CO2) offers an alternative contrast agent in such patients as it is not nephrotoxic. Here, we describe the use of CO2 angiogram coupled with CERAB procedure in AOID with CKD patients, its technical challenges as well as the successful clinical outcomes observed at our facility at the National Heart Institute of Malaysia.