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Objective: Carbon dioxide (CO 2 ) angiography has emerged as a viable alternative to regular iodinated contrast medium (ICM) for guiding endovascular aneurysm repair (EVAR) procedures. This study aimed to evaluate the feasibility and safety of a standardised EVAR procedure using only CO 2 angiography., Methods: A prospective, multicentre, national study enrolled consecutive patients between January 2023 and January 2024 with asymptomatic abdominal aortic aneurysms measuring ≥ 55 mm and for whom standard endovascular graft (instructions for use) was anatomically feasible. The study involved the use of an automatic CO 2 injector to standardise intra-operative imaging. A strategy comprising five standardised steps was devised to visualise a target vessel (TV) that could not be seen during the first CO 2 angiography. The five steps were: (A) place the introducer closer to the TV; (B) tilt the table by 5 - 10° in the direction opposite to the TV; (C) selectively cannulate the TV; (D) cannulate the contralateral gate (only for repositionable devices); CO 2 angiography was repeated in steps 1 - 2; and (E) use ICM., Results: A total of 293 patients were enrolled (10 centres), with a median age of 78 (interquartile range [IQR] 72, 83) years; 256 (87.4%) were male. The overall procedure time, fluoroscopy time, and injected CO 2 volume were 90 (IQR 65, 125) minutes, 15 (IQR 10, 22) minutes, and 600 (IQR 400, 800) mL, respectively. The 30 day mortality, complication, and re-intervention rates were 0.3% (n = 1), 6.8% (n = 20), and 2.4% (n = 7), respectively. CO 2 related adverse events were rare (1%) and minor. A zero iodine contrast EVAR procedure was feasible in 240 (patients 81.9%). The five standardised steps were used extensively: step A, 170 procedures (58.0%); step B, 109 procedures (37.2%); step C, 21 procedures (7.2%); step D, 14 procedures (4.8%); and step E, 53 procedures (18.1%), with a median volume of 20 (IQR 10, 35) mL. Significant predictors for ICM use were aneurysm diameter > 70 mm and a position of the lowermost renal artery between 3 and 9 o'clock., Conclusion: This study demonstrated that the standardised zero iodine contrast EVAR protocol reported here is both safe and feasible and is applicable to 82% of consecutive non-selected patients. Limitations primarily arose from anatomical factors, and adjunctive standardised manoeuvres can effectively address these challenges in most cases., (Copyright © 2024 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)