{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T15:44:17Z","timestamp":1786203857431,"version":"build-2736575974"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"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":["Innovations\ufffd(Phila)"],"abstract":"\n Objective:<\/jats:title>\n \n To introduce a new method to enhance the visualization of renal arteries and the accuracy of graft deployment during CO\n 2<\/jats:sub>\n -assisted endovascular (EV) aneurysm repair (EVAR).\n <\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n A retrospective observational study of consecutive EVAR cases assisted with CO\n 2<\/jats:sub>\n angiography (CO\n 2<\/jats:sub>\n Angio) was conducted. This nonrandomized design reflects real-life progressive attempts to enhance the reliability of CO\n 2<\/jats:sub>\n and intravascular ultrasound (IVUS), minimizing the use of iodinated contrast (IC) and radiation, respectively. Cases were divided into 3 groups according to consecutive periods: CO\n 2<\/jats:sub>\n Angio (\n n<\/jats:italic>\n = 7), CO\n 2<\/jats:sub>\n Angio and balloon occlusion of the infrarenal aorta (CO\n 2<\/jats:sub>\n Angio + EVclamp,\n n<\/jats:italic>\n = 11), and CO\n 2<\/jats:sub>\n Angio + EVclamp + IVUS (\n n<\/jats:italic>\n = 18). IC was permitted in case of insufficient visualization with CO\n 2<\/jats:sub>\n Angio during any phase of the procedure. Demographic, clinical, and procedure variables (volume of IC and CO\n 2<\/jats:sub>\n , radiation, fluoroscopy time, leaks) were collected from electronic clinic histories and statistically analyzed.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n A significant decrease was found in the third group, after introducing both techniques, for total radiation (air kerma; 3,039 \u00b1 2,792.3 vs 3,434.7 \u00b1 1,289.2 vs 2,284.6 \u00b1 841.5 mGy,\n P<\/jats:italic>\n = 0.041), radiation per area, dose area product (47 \u00b1 34.7 vs 54.5 \u00b1 15.3 vs 41.3 \u00b1 12.8 mGy\u00d7m\n 2<\/jats:sup>\n ,\n P<\/jats:italic>\n = 0.03), and IC volume (104.3 \u00b1 102.4 vs 89.2 \u00b1 53.9 vs 15.4 \u00b1 27.4 mL,\n P<\/jats:italic>\n < 0.001), arriving at the goal of \u201czero contrast\u201d in the last 12 patients. No significant differences were detected in fluoroscopy time, total operative time, total CO\n 2<\/jats:sub>\n volume, or change in renal function.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n \n The introduction of endoluminal occlusion with a balloon and the use of IVUS in CO\n 2<\/jats:sub>\n -assisted EVAR enabled us to achieve the objective of zero contrast and a progressive decrease in radiation dose.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/15569845261471885","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T04:36:44Z","timestamp":1786077404000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Zero-Contrast EVAR Can Be Reached Using Automated Carbon Dioxide Digital Angiography, Endoaortic Balloon Occlusion, and IVUS"],"prefix":"10.1177","author":[{"given":"Manuel","family":"Miralles","sequence":"first","affiliation":[{"name":"Angiology and Vascular Surgery Service, Hospital Universitari i Polit\u00e8cnic La Fe, Valencia, Spain"},{"name":"Department of Surgery, Facultat de Medicina, Universitat de Val\u00e8ncia (UV), Spain"},{"name":"Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe), Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca Maria","family":"Mursia","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Service, Hospital Universitari i Polit\u00e8cnic La Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Garc\u00eda Dom\u00ednguez","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Service, Hospital Universitari i Polit\u00e8cnic La Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noelia","family":"Garz\u00f3n","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Service, Hospital Universitari i Polit\u00e8cnic La Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliseo","family":"Candela","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Service, Hospital Universitari i Polit\u00e8cnic La Fe, Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8457-6984","authenticated-orcid":false,"given":"Emma","family":"Plana","sequence":"additional","affiliation":[{"name":"Haemostasis, Thrombosis, Arteriosclerosis and Vascular Biology Research Group, Instituto de Investigaci\u00f3n Sanitaria La Fe (IIS La Fe), Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2851-720X","authenticated-orcid":false,"given":"Sergi","family":"Bellmunt","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Hospital Universitari Vall d\u2019Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.5758\/vsi.2015.31.3.67"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2023.11.002"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/15385744251387760"},{"key":"e_1_3_2_5_2","first-page":"20","article-title":"Automated carbon dioxide digital angiography for lower-limb arterial disease evaluation: safety assessment and comparison with standard iodinated contrast media angiography","volume":"27","author":"Scalise F","year":"2015","unstructured":"Scalise F, Novelli E, Auguadro C, et al. Automated carbon dioxide digital angiography for lower-limb arterial disease evaluation: safety assessment and comparison with standard iodinated contrast media angiography. J Invasive Cardiol 2015; 27: 20\u201326.","journal-title":"J Invasive Cardiol"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2018.01.099"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2011.11.142"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2022.03.768"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.5758\/vsi.2020.36.1.28"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2023.02.038"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/15266028231162258"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2024.11.011"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/0003319715614701"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.25722"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2018.02.036"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.27051"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s42155-020-0103-z"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/7647165"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002709900353"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00270-018-1957-5"},{"key":"e_1_3_2_21_2","first-page":"202","article-title":"Use of intravascular ultrasound in endovascular repair of abdominal aortic aneurysm","volume":"16","author":"Dzieciuchowicz \u0141","year":"2020","unstructured":"Dzieciuchowicz \u0141, Krzy\u017ca\u0144ski R, Nowak A. Use of intravascular ultrasound in endovascular repair of abdominal aortic aneurysm. Adv Interv Cardiol 2020; 16: 202\u2013205.","journal-title":"Adv Interv Cardiol"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semvascsurg.2009.07.009"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1053\/ejvs.2002.1657"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2018.09.016"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2019.11.013"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2022.02.016"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.3109\/02841851.2010.518159"}],"container-title":["Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15569845261471885","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15569845261471885","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15569845261471885","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T15:16:53Z","timestamp":1786202213000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15569845261471885"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":26,"alternative-id":["10.1177\/15569845261471885"],"URL":"https:\/\/doi.org\/10.1177\/15569845261471885","relation":{},"ISSN":["1556-9845","1559-0879"],"issn-type":[{"value":"1556-9845","type":"print"},{"value":"1559-0879","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]},"article-number":"15569845261471885"}}