Contrast associated acute kidney injury (CA-AKI)/Contrast induced acute kidney injury (CI-AKI) is a potential complication of intravenous or intra-arterial iodinated contrast media (ICM) injection during radiological examinations. Presence of certain risk factors, especially pre-existing renal impairment and diabetes mellitus increases the likelihood of a clinically significant acute kidney injury (AKI) [1] and these risk factors overlap with those that predispose the development of peripheral arterial disease. Digital subtraction angiography (DSA) using ICM is considered the gold-standard imaging modality for the diagnosis and treatment of arterial...

All consecutive adult patients who were referred for CO2 lower limb angiography from January 2010 to June 2021 were included. Patients’ CO2 lower limb angiography that did not include below knee run-off arteries were excluded. Angiograms were grouped into CO2-only or CO2 with low-dose ICM (CO2 + ICM) for below knee run-off arteries. The amount of ICM was recorded. The images from each angiogram were randomly and blindly reviewed by two independent radiologists. Overall diagnostic qualities of arterial segments (contrast density, sharpness of vessel contour,...

99 adults (74 males:25 females, mean age =72 with age range of 41-95) with 119 CO2 lower limb angiography were included. There were 36 studies in CO2-only group and 83 studies in CO2 + ICM group with ICM used purely for below knee run-off arteries. Median dose of ICM used was 10ml (range 3.5-32ml) in diagnostic angiograms, and 15ml (range 5-55ml) where there was intervention. The mean diagnostic quality of below knee arteries in the CO2-only group is poor at 1.75 / 5 based on...

While CO2 is often used as a negative contrast in peripheral angiography in severely renal-impaired patients, its image quality is inferior and often non-diagnostic for below knee diseased arteries. This study demonstrates the additional low-volume iodinated contrast helps improve the diagnostic quality of below knee lower limb angiography. Such a small ICM quantity does not result in any clinically significant CA-AKI/CI-AKI risk, which is dose dependent.

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