{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:12:14Z","timestamp":1788567134944,"version":"build-2803163510"},"reference-count":20,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Endovascular Surg"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Contrast-induced nephropathy remains a significant concern in patients undergoing endovascular aneurysm repair (EVAR), particularly those with pre-existing renal impairment. This study aimed to evaluate the feasibility and safety of using a one-quarter diluted contrast agent during EVAR to reduce contrast volume without compromising imaging quality or clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed EVAR procedures performed between July 2022 and September 2024. A total of 96 patients were included, with 50 receiving undiluted contrast and 46 receiving a one-quarter diluted solution. All procedures were conducted using the same angiographic system and protocol. Pixel values and signal-to-noise ratios (SNRs) were measured from digital subtraction angiography (DSA) images. Subjective image quality was independently evaluated by three vascular surgeons using a standardized 5-point scale. Postoperative type I\/III endoleaks were identified on contrast-enhanced CT or ultrasound within 30 days. Statistical comparisons were performed using Welch\u2019s\n                      <jats:italic toggle=\"yes\">t<\/jats:italic>\n                      -test, Mann\u2013Whitney U test, chi-square test, or Fisher\u2019s exact test, as appropriate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Procedural success was achieved in all cases. The diluted group achieved a 70% reduction in contrast volume (19.8 \u00b1 11.5\u00a0mL vs 67.7 \u00b1 30.5\u00a0mL;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Pixel values (2.87 \u00b1 8.75 vs 2.99 \u00b1 5.59;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .936), SNRs, and surgeon-rated image quality were comparable between groups. The incidence of type I\/III endoleaks (2.0% vs 4.3%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .606) and radiation parameters did not differ significantly.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Use of a one-quarter diluted contrast agent during EVAR provided image quality and safety comparable to undiluted contrast while significantly reducing contrast volume. This technique may represent a practical strategy to mitigate renal risk in patients with impaired kidney function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15385744261447457","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T03:49:43Z","timestamp":1777434583000},"page":"614-622","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing Contrast Agent Usage and Evaluating Clinical Safety via Dilution Technique in Endovascular Abdominal Aortic Aneurysm Repair"],"prefix":"10.1177","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5471-6050","authenticated-orcid":false,"given":"Yusuke","family":"Ki","sequence":"first","affiliation":[{"name":"Osaka Keisatsu Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Kuratani","sequence":"additional","affiliation":[{"name":"Osaka Keisatsu Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Oga","sequence":"additional","affiliation":[{"name":"Osaka Keisatsu Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoaki","family":"Kudo","sequence":"additional","affiliation":[{"name":"Osaka Keisatsu Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2018.09.020"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.050686"},{"key":"e_1_3_7_4_2","unstructured":"European Society of Urogenital Radiology (ESUR). 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