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

Nadolski, Gregory J.; Stavropoulos, S. William

doi:10.1016/j.jvs.2012.10.009

Cited by 53 publications

(42 citation statements)

References 48 publications

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“…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

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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.

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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

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“…A phenomenon termed vapour lock, or trapping of gas in the non-dependent vasculature, has been reported in four case reports in the literature 10. It can be broken by changing the patient's position or by aspirating any trapped CO 2 12 and prevented by using a closed CO 2 injection system to avoid contamination with room air 10. Overall, CO 2 is a safe, non-nephrotoxic alternative to traditional iodinated contrast angiography, with potential applications with RAP and CKD.…”

Section: Discussionmentioning

confidence: 99%

Novel use of carbon dioxide arteriography in renal artery pseudoaneurysm in patients with poor renal function

et al. 2014

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Renal artery pseudoaneurysm (RAP) is a rare complication of partial nephrectomy, but is usually effectively managed with renal vessel embolisation. We report a particularly challenging case of a patient with chronic kidney disease (CKD) who developed a RAP following a laparoscopic heminephrectomy and was treated using superselective renal vessel coil embolisation with carbon dioxide (CO2) as the primary contrast agent for arteriographic localisation of the RAP and feeder artery. To the best our knowledge we report the first utilisation of CO2arteriography in the definitive diagnosis and treatment of RAP following heminephrectomy in a patient with severe CKD.

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“…Carbon dioxide angiography (CO2 angiography) is not typically used to evaluate pulmonary arteries due to the fear of CO2 cerebral embolism. 72 V/Q SCAN V/Q scanning can be obtained when patients have anaphylaxis to iodinated contrast, renal failure, and when high levels of radiation is a concern during pregnancy. V/Q scan results need to be interpreted in conjunction with clinical pretest probability, D-dimer, and CUS.…”

Section: Diagnosis Of Pe In Patients With Renal Failurementioning

confidence: 99%

“…The majority of PE patients (2,010,490) in this study were hemodynamically stable, and placement of IVC filters in them did not result in significant difference in mortality. But, use of IVC filters in hemodynamically unstable PE patients (72,230) significantly decreased the mortality when used in conjunction with either thrombolysis or anticoagulation. Fatality rates of unstable PEs were decreased by IVC filters to 33% when compared with 51% with fulldose anticoagulation alone.…”

Section: Use Of Ivc Filters In Unstable Pementioning

confidence: 99%

Practical Approach to VTE Management in Hospitalized Patients

Reddy

Dupree

2017

American Journal of Therapeutics

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Venous thromboembolism (VTE) is a commonly feared life-threatening complication in hospitalized patients. Physicians are frequently consulted to diagnose and manage VTE in obstetrics, neurology, and surgical services. VTE should be treated irrespective of the presentation (incidental or symptomatic), etiology (provoked vs. unprovoked), and location of the venous thrombosis (extremities, abdomen, or cerebral). In patients with high clinical suspicion for VTE, physicians are encouraged to empirically start anticoagulant therapy while awaiting diagnostic testing. Thrombolytic therapy is underused by physicians, which is proven to improve the mortality in hypotensive patients with pulmonary embolism. Retrievable inferior vena cava filters have an important role in the prophylaxis and management of selective groups of VTE patients. Physicians should not hesitate to place retrievable inferior vena cava filters when clinically indicated but also should make every effort to remove them when no longer needed. This article extensively reviews various diagnostic and management options based on several clinical situations.

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

Cited by 53 publications

References 48 publications

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

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

Novel use of carbon dioxide arteriography in renal artery pseudoaneurysm in patients with poor renal function

Practical Approach to VTE Management in Hospitalized Patients

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