Intra-arterial Ultra Low Iodine CT Angiography of Renal Transplant Arteries

Althoff, Christian E.; Günther, Rolf W.; Hamm, Bernd; Rief, Matthias

doi:10.1007/s00270-014-0838-9

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…Excellent visualization of vascular anatomy obtained in all patients, as well as identification of strictures, facilitated proper therapeutic decision-making process with regard to safe and effective renal artery stenting, renouncing this therapeutic method, shortening the time of the procedure, choosing appropriate projection for intervention and, as a result, increased procedure safety. Effectiveness of this method was presented during 2013 ECR [ 12 ] and subsequently in a 2014 publication based on a group of 11 patients [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Intraarterial CT Angiography Using Ultra Low Volume of Iodine Contrast – Own Experiences

et al. 2015

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SummaryBackgroundHigh volume of intravenous contrast in CT-angiography may result in contrast-induced nephropathy. Intraarterial ultra-low volume of contrast medium results in its satisfactory blood concentration with potentially good image quality. The first main purpose was to assess the influence of the method on function of transplanted kidney in patients with impaired graft function. The second main purpose of the study was to evaluate the usefulness of this method for detection of gastrointestinal and head-and-neck haemorrhages.Material/MethodsBetween 2010 and 2013 intraarterial CT-angiography was performed in 56 patients, including 28 with chronic kidney disease (CKD). There were three main subgroups: 18 patients after kidney transplantation, 10 patients with gastrointestinal hemorrhage, 8 patients with head-and-neck hemorrhage. Contralateral or ipsilateral inguinal arterial approach was performed. The 4-French vascular sheaths and 4F-catheters were introduced under fluoroscopy. Intraarterial CT was performed using 64-slice scanner. The scanning protocol was as follows: slice thickness 0.625 mm, pitch 1.3, gantry rotation 0.6 sec., scanning delay 1–2 sec. The extent of the study was established on the basis of scout image. In patients with CKD 6–8 mL of Iodixanol (320 mg/mL) diluted with saline to 18–24 mL was administered at a speed of 4–5 mL/s.ResultsVasculature was properly visualized in all patients. In patients with impaired renal function creatinine/eGFR levels remained stable in all but one case. Traditional arteriography failed and CT-angiography demonstrated the site of bleeding in 3 of 10 patients with symptoms of gastrointestinal bleeding (30%). In 8 patients with head-and-neck bleeding CT-angiography did not prove beneficial when compared to traditional arteriography.Conclusions1. Ultra-low contrast intraarterial CT-angiography does not deteriorate the function of transplanted kidneys in patients with impaired graft function. 2. 3D reconstructions allow for excellent visualization of vascular anatomy of renal transplants. 3. Intraarterial CT-angiography is useful for detection of the bleeding site.

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Section: Discussionmentioning

confidence: 99%

Intraarterial CT Angiography Using Ultra Low Volume of Iodine Contrast – Own Experiences

et al. 2015

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“…Nevertheless, it requires administration of a high volume of iodine contrast, which carries a risk of graft failure in patients with already impaired graft function. Several studies proved that ultra-low-volume iodine contrast administered intra-arterially during CTA ensures optimal technical feasibility of this imaging method [10,11]. Moreover, intra-arterial puncture can be used for percutaneous intraluminal angioplasty and or without stent implantation in one step with CTA on condition that there is a short distance between the cath lab and CT room [10], as it was in the cases presented in this study.…”

Section: Discussionmentioning

confidence: 80%

Intra-arterial computed tomography angiography with ultra-low volume of iodine contrast and stent implantation in transplant renal artery stenosis in terms of contrast-induced kidney injury – a preliminary report

et al. 2020

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PurposeTraditional digital subtraction angiography is still regarded as the gold standard in the diagnostics of transplant renal artery stenosis (TRAS). However, this procedure requires a high volume of iodine contrast medium for optimal visualisation of the renal artery. The aim of this study was to analyse both the usefulness and the safety of intra-arterial computed tomography angiography (IA-CTA) with ultra-low-volume iodine contrast administration in the diagnostic and therapeutic management of TRAS in patients with impaired renal transplant function.Material and methodsThirty-three patients with a suspicion of TRAS based on Doppler-ultrasound and clinical setting underwent IA-CTA with ultra-low iodine contrast volume. A special, author-elaborated CTA protocol was used. The volume of 8-18 ml of diluted iodine contrast medium was administered through a catheter with the tip placed 2 cm below the aortic bifurcation.ResultsIn six patients the CTA examinations revealed TRAS in three configurations: in the anastomosis, in the trunk (critical and high-grade), or in both sections. Stenoses were treated with primary stenting obtaining favourable anatomical outcome. No intervention-related complications were observed. No contrast-induced acute kidney injury was diagnosed in this study. Mean serum creatinine concentration was 2.93 ± 0.89 mg/dl at the baseline and 2.89 ± 1.73 mg/dl and 2.17 ± 0.51 mg/dl after three and seven days from IA-CTA, respectively.ConclusionsIntra-arterial CTA with ultra-low volume of iodine contrast seems to be a safe and reliable diagnostic tool to detect and assess TRAS in the aspect of stent implantation. Application of this imaging modality eliminates the need for a high volume of iodine contrast and thus does not adversely influence renal transplant function.

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“…21 Standard CTA is not an alternative due to the high CM dose needed, almost 40 g of iodine. 22,23 A technique to combine CTA with invasive placement of a micro-catheter in the supplying artery has successfully reduced the dose to 5-20 mL, 24 but this is an invasive technique and requires the interaction of an interventionist. A one-stop-shop alternative is to perform DSA without prior imaging.…”

Section: Discussionmentioning

confidence: 99%

Visualization of the renal artery in kidney transplant patients using time-resolved computed tomography angiography

Anders

Genberg

Brehmer

et al. 2021

Acta Radiologica Open

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Background Transplant renal artery stenosis (TRAS) is a post-operative complication which most often occurs between 3 months and 2 years after transplantation. TRAS is associated with kidney failure and hypertension and, thereby, with an increased risk of cardiovascular events. Purpose The purpose of this retrospective study was to report our experience of perfusion computed tomography angiography (P-CTA) to identify a 50% lumen reduction (as compared to digital subtraction angiography, DSA), assess its subjective image quality and evaluate if contrast-induced acute kidney injury (CI-AKI) occurred. Material and Methods All 13 patients who had undergone P-CTA for suspected TRAS at our institution were retrospectively evaluated. At P-CTA, eight or 12 g of iodine were administered intravenously, and five to seven scan sequences were merged into time-resolved images after motion correction. Eight patients underwent subsequent DSA. Results The average patient weight was 76 kg (range 55–97 kg). Image quality was rated as good or excellent for all patients, and pathological changes were shown in 10 of 13 patients undergoing P-CTA. Two patients had a serum creatinine increase of >26 μmol/L during the first 3 days, but serum creatinine was significantly lower in all patients 1 month after P-CTA (165+/−69 μmol/L versus 232+/−66 μmol/L, P < .01). The diagnosis at P-CTA was verified in all eight patients who underwent DSA. However, in two cases with suspected stenosis, renal function was restored without angioplasty. Conclusion Anatomy and blood flow of the transplant renal artery can be visualized using less than a third of the standard contrast media dose by using P-CTA technique.

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Intra-arterial Ultra Low Iodine CT Angiography of Renal Transplant Arteries

Abstract: Wide detector ia-CTA for the diagnosis of TRAS is feasible using very low doses of contrast agent and results in high image quality.

Cited by 8 publications

References 17 publications

Intraarterial CT Angiography Using Ultra Low Volume of Iodine Contrast – Own Experiences

Intraarterial CT Angiography Using Ultra Low Volume of Iodine Contrast – Own Experiences

Intra-arterial computed tomography angiography with ultra-low volume of iodine contrast and stent implantation in transplant renal artery stenosis in terms of contrast-induced kidney injury – a preliminary report

Visualization of the renal artery in kidney transplant patients using time-resolved computed tomography angiography

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