The use of the AVERT system to limit contrast volume administration during peripheral angiography and intervention

Anand Prasad, Carolina Ortiz-Lopez, David M. Kaye, Melissa Byrne, Shane Nanayakkara, Shah-hinan Ahmed, Steven R Bailey, Roxana Mehran, Salil Sethi, Avantika Banerjee, Marvin Eng

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background The AVERT™ Contrast Modulation System (AVERT) (Osprey Medical, MN) is designed to reduce contrast volume administration during angiography. The AVERT provides an adjustable resistance circuit which decreases the pressure head delivering contrast towards the patient. The AVERT has not been previously studied in patients undergoing peripheral digital subtraction angiography (DSA). The purpose of this study was (1) to evaluate contrast savings with the AVERT and (2) to evaluate the ability to generate clinically acceptable DSA images in the process. To better define the mechanism of action in the peripheral circulation, we also developed a bench model to study the effects of the AVERT on the hydrodynamics of contrast delivery. Methods Patients undergoing lower extremity DSA (diagnostic or intervention, sheath or catheter) were studied. The following variables were recorded for each injection: starting control syringe contrast volume, contrast volume injected towards patient, contrast volume returned to AVERT reservoir, net contrast administered to the patient and % savings. The AVERT resistance was adjusted manually based on operator's discretion - balancing image quality and contrast savings. Results About 408 DSA angiographic sequences were obtained in 22 patients undergoing 29 procedures. Almost 68% of the patients had chronic kidney disease. An 82% presented with critical limb ischemia, 18% had claudication. There was an overall 37% ± 14% savings of contrast (31% for diagnostic DSA, 40% for interventional procedures). Overall 91% of all images were acceptable for clinical decision making. Specifically, 94% of diagnostic and 87% of interventional images were acceptable. Injection through a 4 Fr catheter (77% acceptable) resulted in poorer image quality as compared to a 5 Fr catheter (96% acceptable). Image quality for 5, 6, and 7 Fr sheath injections was 86%, 91%, 98%, respectively. The bench model of peripheral angiography demonstrated a significant reduction in reflux of contrast proximal to the end of the catheter without loss of antegrade image quality - confirming the in vivo findings. Conclusions We demonstrate that the use of the AVERT device during peripheral angiography results in significant contrast savings without compromising image quality.

Original languageEnglish (US)
Pages (from-to)1228-1233
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume86
Issue number7
DOIs
StatePublished - Dec 1 2015

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Digital Subtraction Angiography
Angiography
Catheters
Injections
Syringes
Hydrodynamics
Chronic Renal Insufficiency
Lower Extremity
Ischemia
Extremities
Pressure
Equipment and Supplies

Keywords

  • angiographic/fluoroscopic
  • angiography
  • contrast agents
  • critical
  • endovascular intervention
  • Imaging
  • limb ischemia
  • peripheral intervention
  • peripheral/renal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

The use of the AVERT system to limit contrast volume administration during peripheral angiography and intervention. / Prasad, Anand; Ortiz-Lopez, Carolina; Kaye, David M.; Byrne, Melissa; Nanayakkara, Shane; Ahmed, Shah-hinan; Bailey, Steven R; Mehran, Roxana; Sethi, Salil; Banerjee, Avantika; Eng, Marvin.

In: Catheterization and Cardiovascular Interventions, Vol. 86, No. 7, 01.12.2015, p. 1228-1233.

Research output: Contribution to journalArticle

Prasad, A, Ortiz-Lopez, C, Kaye, DM, Byrne, M, Nanayakkara, S, Ahmed, S, Bailey, SR, Mehran, R, Sethi, S, Banerjee, A & Eng, M 2015, 'The use of the AVERT system to limit contrast volume administration during peripheral angiography and intervention', Catheterization and Cardiovascular Interventions, vol. 86, no. 7, pp. 1228-1233. https://doi.org/10.1002/ccd.26155
Prasad, Anand ; Ortiz-Lopez, Carolina ; Kaye, David M. ; Byrne, Melissa ; Nanayakkara, Shane ; Ahmed, Shah-hinan ; Bailey, Steven R ; Mehran, Roxana ; Sethi, Salil ; Banerjee, Avantika ; Eng, Marvin. / The use of the AVERT system to limit contrast volume administration during peripheral angiography and intervention. In: Catheterization and Cardiovascular Interventions. 2015 ; Vol. 86, No. 7. pp. 1228-1233.
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abstract = "Background The AVERT™ Contrast Modulation System (AVERT) (Osprey Medical, MN) is designed to reduce contrast volume administration during angiography. The AVERT provides an adjustable resistance circuit which decreases the pressure head delivering contrast towards the patient. The AVERT has not been previously studied in patients undergoing peripheral digital subtraction angiography (DSA). The purpose of this study was (1) to evaluate contrast savings with the AVERT and (2) to evaluate the ability to generate clinically acceptable DSA images in the process. To better define the mechanism of action in the peripheral circulation, we also developed a bench model to study the effects of the AVERT on the hydrodynamics of contrast delivery. Methods Patients undergoing lower extremity DSA (diagnostic or intervention, sheath or catheter) were studied. The following variables were recorded for each injection: starting control syringe contrast volume, contrast volume injected towards patient, contrast volume returned to AVERT reservoir, net contrast administered to the patient and {\%} savings. The AVERT resistance was adjusted manually based on operator's discretion - balancing image quality and contrast savings. Results About 408 DSA angiographic sequences were obtained in 22 patients undergoing 29 procedures. Almost 68{\%} of the patients had chronic kidney disease. An 82{\%} presented with critical limb ischemia, 18{\%} had claudication. There was an overall 37{\%} ± 14{\%} savings of contrast (31{\%} for diagnostic DSA, 40{\%} for interventional procedures). Overall 91{\%} of all images were acceptable for clinical decision making. Specifically, 94{\%} of diagnostic and 87{\%} of interventional images were acceptable. Injection through a 4 Fr catheter (77{\%} acceptable) resulted in poorer image quality as compared to a 5 Fr catheter (96{\%} acceptable). Image quality for 5, 6, and 7 Fr sheath injections was 86{\%}, 91{\%}, 98{\%}, respectively. The bench model of peripheral angiography demonstrated a significant reduction in reflux of contrast proximal to the end of the catheter without loss of antegrade image quality - confirming the in vivo findings. Conclusions We demonstrate that the use of the AVERT device during peripheral angiography results in significant contrast savings without compromising image quality.",
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AU - Nanayakkara, Shane

AU - Ahmed, Shah-hinan

AU - Bailey, Steven R

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