Arteriography in chronic renal failure: a case for carbon dioxide

Fitridge, Robert; Petrucco, M.; Dunlop, Craig; Thompson, M. M.; Sebben, Ruben

doi:10.1016/s0967-2109(98)00131-8

Cited by 14 publications

(5 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Foremost, CO 2 is nonallergenic and nonnephrotoxic, making it safe for use in patients with either contrast allergy or kidney disease. [21][22][23][24][25] Essentially unlimited volumes of CO 2 can be used, assuming sufficient time is allowed for the gas to be eliminated from the body. Carbon dioxide even is safe in patients with chronic lung disease with CO 2 retention, as long as additional time is taken between injections to allow for the gas to be cleared by the lungs.…”

Section: Carbon Dioxidementioning

confidence: 99%

Contrast alternatives for iodinated contrast allergy and renal dysfunction: Options and limitations

Nadolski

Stavropoulos

2013

Journal of Vascular Surgery

View full text Add to dashboard Cite

Diagnostic angiography and vascular interventions make routine use of iodinated contrast material (ICM). Patients with renal disease or contrast allergy pose limitations on the use of ICM. In such cases, alternative contrast media may be used to carry out the procedure. Current alternatives include carbon dioxide, gadolinium, and dilute ICM. Each of these alternatives has its own unique features and limitations. In the present review article, the current alternatives to ICM are explored, with a focus on the applications and restrictions of each.

show abstract

Section: Carbon Dioxidementioning

confidence: 99%

Contrast alternatives for iodinated contrast allergy and renal dysfunction: Options and limitations

Nadolski

Stavropoulos

2013

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…Carbon dioxide (CO 2 ) was introduced many years ago (1950s-1960s) as a non-iodine based alternative to contrast media for use during invasive angiographic studies either for diagnostic or therapeutic purposes. Its main advantage is that it is neither allergenic nor nephrotoxic making it safe to use in patients with either severe allergy to iodine CM or those suffering from renal impairment and where kidney protection is warranted (Fitridge et al, 1999;Hawkins et al, 2009;Nadolski & Stavropoulos, 2013). It may be given in unlimited amounts as it is rapidly cleared by the lungs, and is considered very safe for use under the level of the diaphragm.…”

Section: Introductionmentioning

confidence: 99%

Carbon dioxide angiography during peripheral angioplasty procedures significantly reduces the risk of contrast-induced nephropathy in patients with chronic kidney disease

et al. 2020

View full text Add to dashboard Cite

Background: Iodinated contrast media are amongst the most frequently prescribed medications, however, their use is not without complications. With contrast-induced nephropathy constituting a major concern, alternative noniodine based approaches have been explored such as carbon dioxide angiography. The purpose of this study is to report the incidence of contrast-induced nephropathy following carbon dioxide angiography in patients with impaired renal function that underwent peripheral angioplasty compared with a historical cohort of patients that underwent angioplasty with use of solely iodine contrast medium. The historical cohort of patients treated with iodinated contrast was used as control. Baseline demographics and renal function tests were recorded. Primary outcome was incidence of contrast-induced nephropathy within 48-72 h post intervention. Receiver-Operating-Characteristic curve analysis was used to correlate the volume of iodinated contrast with the risk of contrastinduced nephropathy. Results: Carbon Dioxide was used as an alternative to iodinated contrast media in patients with impaired renal function (eGFR<60mls/min/1.73 m2) undergoing peripheral angioplasty procedures. Fifty, consecutive patients (baseline eGFR = 38.6 ± 13.2mls/min/1.73 m2) were included in a prospective clinical audit. These were matched (1: 2) with a historical cohort of patients (baseline eGFR = 43.3 ± 12.2mls/min/1.73 m2) treated with Iodinated contrast media. The incidence of contrast-induced nephropathy was 14% (n = 7/50) in case of carbon dioxide vs. 29% (n = 29/100) in the matched cohort group (p = 0.045). Receiver-Operating-Characteristic analysis showed that use of >25mls of contrast was 94.4% (95% CI:81-99%) sensitive in predicting contrast-induced nephropathy. Conclusion: Carbon dioxide imaging during peripheral angioplasty procedures protects against contrast-induced nephropathy. Use of >25mls of iodinated contrast media in high-risk patients is a predictor of contrast-induced nephropathy.

show abstract

“…Other alternative imaging modalities may also be considered as useful additions to the spectrum of available non-nephrotoxic options. Carbon dioxide arteriography has been used extensively for preoper-ative and intraoperative imaging [23][24][25][26]. This technique utilizes the negative contrast produced by CO 2 gas as it travels through the vascular system to produce an image.…”

Section: Resultsmentioning

confidence: 99%

Endovascular AAA Repair in Patients with Renal Insufficiency: Strategies for Reducing Adverse Renal Events

Carpenter,

Fairman,

Barker

et al. 2001

Cardiovascular Surgery

View full text Add to dashboard Cite

Vascular imaging, usually employing nephrotoxic contrast agents is relied upon for all aspects of endovascular AAA repair causing some to consider renal insufficiency a relative contraindication. We sought to determine if endovascular AAA evaluation and repair could be successfully accomplished by minimally or non-nephrotoxic modalities. Records and results for 98 consecutive patients undergoing endovascular AAA repair were reviewed. Patients requiring dialysis preoperatively were excluded ( N =3). The average volume of iodinated contrast agent employed for intraoperative imaging was 152 cc (35–420 cc). Twenty patients (20%) had baseline renal insufficiency (serum creatinine ≥1.3 mg/dl). A rise in serum creatinine above baseline was observed in 23 (24%) patients following repair: for 15 (16%) this was permanent. Creatinine rise occurred in patients with both normal (15) and abnormal (8) baseline values ( P=0.09). Rise in creatinine was independent of contrast volume employed and of the use of infrarenal vs suprarenal device fixation ( P>0.05). Two (2%) patients required permanent dialysis, one of which had a normal baseline creatinine and unclear etiology for renal failure, the other had a baseline creatinine of 2 and required device placement over an accessory renal artery. Strategies to minimize the use of nephrotoxic contrast for patients with renal insufficiency included the use of MRA, rather than contrast-CT for pre and postoperative imaging (7. 35%) and use of Gadolinium rather than iodinated contrast for performance of intraoperative arteriography (5. 25%). Endovascular grafts were successfully designed and implanted based upon MRA as the sole preoperative imaging modality in every case in which it was attempted (7). Mortality was not significantly different between those with and without abnormal baseline renal function ( P>0.05). Adverse events (access failures, arterial injuries, blood loss, endoleaks) were not significantly correlated with baseline renal insufficiency, rise in creatinine from baseline, use of MRA or intraoperative Gadolinium angiography ( P>0.05). Pre- and postoperative evaluation and performance of endovascular AAA repair can be accomplished in patients with renal insufficiency without increasing the rate of mortality or adverse events employing a strategy which minimizes the use of nephrotoxic contrast agents, relying upon Gadolinium arteriography and MRA. Endovascular grafts can be successfully planned and followed employing MRA as the sole imaging modality.

show abstract

Arteriography in chronic renal failure: a case for carbon dioxide

Cited by 14 publications

References 12 publications

Contrast alternatives for iodinated contrast allergy and renal dysfunction: Options and limitations

Contrast alternatives for iodinated contrast allergy and renal dysfunction: Options and limitations

Carbon dioxide angiography during peripheral angioplasty procedures significantly reduces the risk of contrast-induced nephropathy in patients with chronic kidney disease

Endovascular AAA Repair in Patients with Renal Insufficiency: Strategies for Reducing Adverse Renal Events

Contact Info

Product

Resources

About