Gadolinium-Enhanced Angiography for Diagnosis and Interventional Treatment of Subclavian Artery Stenosis Prior to Fistula Creation

Abstract

We report the use of gadolinium-based contrast agent for both diagnostic and interventional subclavian angiography in two azotemic patients, presenting with an asymptomatic, high-grade stenosis of the left subclavian artery, ipsilateral to the site of choice for native fistula creation. Angiographic imaging performed with diluted gadolinium-based contrast material was clear enough to perform successful subclavian artery stenting, resulting in normalization of the arterial blood pressure in the afferent artery of the dialysis fistula. Clinically, no decrease in residual renal function and no other complication were noted immediately or a longer period after the interventional treatment.

A Novel Technique to Reduce Contrast Exposure During Subclavian Interventions

“…3 Gadolinium or carbon dioxide contrast media can be used to reduce iodized load, but each has its own limitations. 4,5 The presented clinical case describes a simple technique to minimize total body contrast exposure while maintaining efficacy of angiographic evaluation. Along these lines, previous studies have evaluated the removal of contrast from the downstream venous system after arterial angiography in swine and bench models.…”