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Safety of CO₂- and Gadodiamide-Enhanced Angiography for the Evaluation and Percutaneous Treatment of Renal Artery Stenosis in Patients with Chronic Renal Insufficiency

¹ Department of Radiology, University of Virginia Health System, Lee St., Box 170, Charlottesville, VA 22908.
² Department of Health Evaluation Sciences, University of Virginia Health System, Charlottesville, VA 22908.
³ Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908.
⁴ Department of Medicine, Martha Jefferson Hospital, Locust Ave., Charlottesville, VA 22901.

OBJECTIVE. The objective of our study was to evaluate the safety of CO₂ and gadodiamide angiography for diagnosing and percutaneously treating renal artery stenosis in patients with chronic renal insufficiency and presumed ischemic nephropathy.

SUBJECTS AND METHODS. One hundred forty-six consecutive patients with chronic renal insufficiency (serum creatinine > 1.5 mg/dL) were examined for renal artery stenosis using CO₂ and gadodiamide as the angiographic contrast agents. If renal artery stenosis was detected, percutaneous balloon angioplasty with or without stenting was performed. In patients for whom 48-hr creatinine levels were available, we performed an analysis to determine the incidence of contrast-involved nephropathy (increase in serum creatinine of 0.5 mg/dL at 48 hr without identifiable cause). Major complications were reported up to 1 week, and mortality was reported up to 30 days after the procedure.

RESULTS. Ninety-five patients had serum creatinine levels available at 48 hr. An increase in creatinine of greater than 0.5 mg/dL at 48 hr occurred in three patients (3.2%), presumably caused by CO₂, by gadodiamide, or by both. Neither diabetes nor the degree of preexisting chronic renal insufficiency was a predictor of worsening renal function 48 hr after the procedure. The volumes of CO₂ and gadodiamide used for diagnostic studies alone versus the volume used for interventional studies was not significantly different (for CO₂, p = 0.09; for gadodiamide, p = 0.30). Eleven major complications occurred in eight patients (5.5%). Two deaths (1.4%) occurred within 30 days. One death was due to cholesterol embolization and the other was not believed to be related to the procedure.

CONCLUSION. Angiography and percutaneous treatment of renal artery stenosis in patients with chronic renal insufficiency and suspected ischemic nephropathy can be performed relatively safely using CO₂ and gadodiamide as angiographic contrast agents without an increased risk of complications. Contrast-induced nephropathy potentially occurred in 3.2% of patients. Neither the degree of underlying renal insufficiency nor diabetes was a risk factor for predicting a greater likelihood of renal function worsening at 48 hr of follow-up. The volumes of CO₂ and gadodiamide used in this study did not result in an increased risk of contrast-involved nephropathy.

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