• A Prospective Study for Evaluation of Efficacy of Ligation of the Intersphincteric Fistula Tract (Lift) for Treatment of Patints with Fistula-In-Ano
    Mustafa Biomy and Eslam M. Ibrahim
  • A Comparison of Laparoscopic and Open Repair of Perforated Duodenal Ulcer Using Omental Patch: A Prospective Randomized Controlled Trial
    Tamer Alsaied Alnaimy , Tamer Rushdy Elalfy and Mohammed A.Elkilany
  • The Value of Preoperative Ultrasound In Predicting Technical Difficulties During Laparoscopic Cholecystectomy
    Ahmed Mahmoud Hussein1 M.D.; Ahmed Abd Alaziz Mohammad1 M.D.; Ahmed Mohammed Ahmed Nasser2 M.Sc.
  • Iliofemoral Venous Stenting for Patients with Chronic Post-thrombotic Venous Occlusive Disease
    Sherif Essam Eldin Tawfik, MD; Abdelrahman Mohamed Salem, MD
  • Peroneal Artery Angioplasty As a Single Runoff Vessel for Foot Revascularization in Patients with Critical Limb Ischemia
    Abdelrahman Mohammed, MD, Ahmed Kamal Gabr, MD, Sherif Essam Eldin Tawfik, MD
  • Fat Harvesting from the Excised Dermolipectomy Flaps for Fat Augmentation in Various Individuals
    Ashraf Elsebaie MD, Ahmed Abdelsalam Hafiz MD, Ahmed Maher MD, Rasha Abdelkader MD
  • Evelauation of the use of Gastrisailtm Gastric Positioning Device during Laparoscopic Sleeve Gastrectomy, Early Experince
    Ahmed M.S.M Marzouk, Haitham S. Omar
  • Feasibility of Round Block Mammoplasty As a Single Technique For Different Quadrants T1,T2 Malignant Breast Lesions. Fayoum University Hospital experience. A study of 25 patients.
    Hany F. Habashy
  • Laparoscopic Cholecystectomy following ERCP in One Day: A Retrospective Study
    Maged Rihan, MD, MRCS
  • Sleeve Gastrectomy with Hiatus Hernia Repair in 25 Egyptian Morbid Obese : Short Term Results
    Karim Sabry (MD, MRCS) , Wael A Jumuah (MD) ,Yasser El Ghamrini (MD)
  • Polypropylene Suture Fixation versus Fibrin Glue in Lichtenstein Inguinal Hernia Repair: A Prospective Randomized Study
    Ahmed Shoka, MD, MRCS, Fady Makram, MD, FACS, Mohamed Matar, MD, FACS.
  • Effect of Two Bariatric Procedures on Macro- and Micronutrient Levels Inspite of Multivitamin Supplementation
    Mohammed Matar,1 MD, FACS, Ahmed Shoka,1 MD, MRCS, Heba Nader,2 MD
  • Complicated Acute Cholecystitis; Protocol of Management
    Mokhtar Abd Elrahman Bahbah, MD; Ehab M Oraby, MD.
  • Motor Bike Accident is a Main Cause of Maxillofacial Fractures Presenting to Cairo University Hospitals: A Retrospective Study
    Youssif Khachaba, Waleed Reda, Ahmed Abd El Salam, Ahmed Samy Saad Hussein, Nadeen Mohamed El Essawy, Ashraf El Sebaie
  • Early Results of Arterioarterial Prosthetic Loop As a Bail Out Procedure in End Stage Renal Disease Patients With Multi-Access Failure
    Naguib Abdelkreem ElAskary MD, Ahmed Osmane MD
  • The Role of Carbon Dioxide As a Safe Contrast Agent in Endovascular Treatment of Chronic Lower Limb Ischemia in Patients with Renal Impairment or Iodinated Contrast Allergy
    Mahmoud Hamda MS, Naguib Abdelkreem ElAskary MD, Ahmed Osmane MD
  • Plastibell Versus Bone Cutting Techniques in Neonatal and Infantile Circumcision: A Retrospective Study and Review of Outcomes
    Ahmed M.S.M. Marzouk
  • Modalities of Pre-Operative Marking Techniques for Breast Reduction & Mastopexy
    1Waleed AlBadry, MSc, MRCS;1Raafat Gohar, MD; 1Ashraf El-Sebaie; 2Mohamed Salah, MD;1Mohamed Ashraf El Meleigy, MD
  • The Role of Carbon Dioxide As a Safe Contrast Agent in Endovascular Treatment of Chronic Lower Limb Ischemia in Patients with Renal Impairment or Iodinated Contrast Allergy

    Mahmoud Hamda MS, Naguib Abdelkreem ElAskary MD, Ahmed Osmane MD
    Department of Vascular Surgery – Alexandria University

    Background: Peripheral arterial disease (PAD) is a common health problem and its risk is higher among patients with chronic kidney disease. The use of conventional iodinated contrast media (ICM) in angioplasty is associated with many hazards like contrast induced nephropathy and iodinated contrast allergy. The morbidity of contrast media is 5% and the mortality is 0.006%. CO2 has emerged as an alternative or adjuvant to ICM in vascular imaging, as it has many advantages. It is non-allergic, lacks renal toxicity and is a highly soluble gas. When injected into the arteries, CO2 acts as a negative contrast agent displacing the blood in the arteries and imaging devices identify the density difference between the gas and the surrounding soft tissues. The homemade plastic bag delivery system was introduced as a cheap and effective method for CO2 delivery. Aim of the work: assessment of the procedural success and complications associated with the use of CO2 angiography in endovascular treatment of chronic lower limb ischemia in patients with renal impairment or ICM allergy. Patients and methods: Thirty patients complaining of chronic lower limb ischemia, with lesions amenable for endovascular dilatation and have renal impairment or ICM allergy were treated by angioplasty using CO2 as a main contrast agent, complemented by iodinated contrast when needed. CO2 angiography was done using he homemade plastic bag delivery system. Patient demographics, clinical details, preoperative and postoperative renal function were recorded. After the procedure the patients were observed for 24 hours for any clinical incidents or endovascular complications. ABI was measured 24 hours following the endovascular procedure. All patients had regular follow up visits at one week and one month for evaluation of the procedure according to Rutherford guidelines. Results: The clinical presentation of the studied cases varied between intermittent claudication in 10 patients and critical limb ischemia in the remaining 20 patients (either as rest pain in 9 patients or trophic changes and minor tissue loss in 11 patients). The angiographic images obtained by CO2 were of accepted quality to guide the decision in angioplasty procedures in all cases. Hemodynamic success was achieved in all cases with increase of mean ABI from 0.54 ± 0.25 SD before the procedure to 0.91 ± 0.12 SD after it. The mean amount of ICM used was about 13.75 ml ± 5.58 SD and the median was 10.5 ml. Three cases, had ICM allergy, were performed exclusively by CO2 without the use of ICM. In the 30 angioplasty procedures performed, we encountered 41 arterial lesions, which were classified into iliac, femoral, popliteal or tibial regions by a percentage of 4.9%, 36.6%, 9.8% and 48.7% respectively. We succeeded to dilate 39 of those lesions, so technical and anatomical success was achieved in 95% of lesions. We had no complications related to air embolism in the studied 30 cases. As regard renal function, there was significant decrease in the mean serum creatinine value from 3.35 mg/dl ± 1.36 SD preprocedural to 3.07 mg/dl ± 1.35 SD post-procedural. Intraoperative nausea and vomiting occurred in two patients which were simply managed by antiemetic drugs with no sequel post-operatively. Conclusion: CO2 can be used as an alternative to or adjuvant to ICM in patients with renal impairment to decrease the risk of CIN associated with the use of large amounts of ICM and to prevent anaphylactic reactions that may be fatal in patients with ICM allergy. Key words: CO2 angiography - angioplasty – chronic lower limb ischemia.