{
  "abstract": "Background/Objectives: Patients with chronic kidney disease (CKD) who undergo complex femoropopliteal endovascular interventions are at heightened risk of contrast-associated acute kidney injury (CA-AKI). This study assessed technical feasibility, short-term creatinine-based renal outcomes, and clinical outcomes of a zero-iodinated-contrast, carbon dioxide (CO2)-guided atherectomy approach for chronic total occlusions (CTOs) of the superficial femoral artery (SFA). Materials and Methods: In this retrospective, single-center analysis, 25 non-dialysis patients with CKD underwent CO2-only angiography-guided atherectomy for SFA CTOs. Renal function, procedural characteristics, distal embolization, limb-related outcomes, and duplex ultrasound-defined patency were evaluated. Serum creatinine was measured at baseline and within 48 h after the procedure. Results: The mean age was 65.4 ± 9.8 years, and 36% of patients presented with chronic limb-threatening ischemia (CLTI). Baseline serum creatinine was 2.16 ± 0.44 mg/dL, and the estimated glomerular filtration rate (eGFR) was 29.5 ± 9.1 mL/min/1.73 m2; 56% of patients had Stage 4 CKD. Technical success was achieved in all procedures. Cumulative CO2-volume data were available for 24 patients, with a mean volume of 98.8 ± 37.6 mL, and the mean procedure duration was 38.2 ± 17.2 min. Distal embolization occurred in 20% of patients (5/25), including one event requiring catheter-directed thrombolysis; all embolic events were treated endovascularly, with near-complete recanalization in the thrombolysis case. Mean serum creatinine changed by −0.016 ± 0.086 mg/dL, and no creatinine-defined AKI was observed within the available 48-h assessment. No patient required initiation of dialysis. Follow-up outcomes were available for 24 of 25 patients (96%); one patient was lost to follow-up. Over a mean follow-up period of 26 months (with incompletely reconstructed surveillance), no duplex-defined restenosis, recurrent CTO, or target lesion revascularization (TLR) was documented among patients with available follow-up imaging; this is a descriptive observation within the available follow-up and does not establish universal or long-term freedom from restenosis. Conclusions: A zero-iodinated-contrast, CO2-guided atherectomy strategy appears technically feasible for SFA CTO revascularization in patients with advanced CKD and was associated with observed short-term creatinine stability within the available 48-h assessment in this small retrospective cohort. These preliminary observations require validation in larger, prospective, controlled studies.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Radiology, Gazi Yaşargil Training and Research Hospital, University of Health Sciences, Diyarbakır 21090, Turkey",
    "Department of Anatomy, Faculty of Medicine, Dicle University, Diyarbakir 21200, Turkey"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Özgür Zülfükar Ertuğrul",
      "orcid": "0000-0002-7178-2164"
    },
    {
      "affs": [
        1
      ],
      "name": "Esma Deniz Barc",
      "orcid": "0000-0003-4636-4312"
    },
    {
      "affs": [
        1
      ],
      "name": "Mehmet Cudi Tuncer",
      "orcid": "0000-0001-7317-5467"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6v263qgbwk2hb.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15218709",
  "fulltext_url": null,
  "id": "6v263qgbwk2hb",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/21/8709",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-08",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/6v263qgbwk2hb.ris",
  "sources": [
    {
      "first_seen": "2026-11-10T00:21:41Z",
      "native_id": "10.3390/jcm15218709",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/21/8709"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Zero-Iodinated-Contrast CO2-Guided Atherectomy for Superficial Femoral Artery Chronic Total Occlusions in Advanced Chronic Kidney Disease",
  "title_text": "Zero-Iodinated-Contrast CO2-Guided Atherectomy for Superficial Femoral Artery Chronic Total Occlusions in Advanced Chronic Kidney Disease",
  "type": "peer-reviewed",
  "updated_at": "2026-11-10T00:21:41Z",
  "url": "https://research.draconitic.com/paper/6v263qgbwk2hb",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}