Keywords:
Contrast agents, Extremities, Interventional vascular, Catheter arteriography, Angioplasty, Contrast agent-other, Diagnostic procedure, Arteriosclerosis, Obstruction / Occlusion
Authors:
J. Friesen, B. Friesen, K. K. Lau
DOI:
10.26044/ranzcr2022/R-0128
Purpose
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 and venous pathologies. Interventions including angioplasty with balloon, stenting, clot retrieval or catheter-directed thrombolysis may also occur in the same setting of DSA, which may expose a patient to significant volumes of ICM during the examination and procedure. Many patients where DSA is indicated to diagnose and/or treat lower limb arterial occlusions may have renal impairment which is a relative contraindication to ICM injection.
Carbon dioxide (CO2), excreted by lungs, has been used as a non-nephrotoxic and non-allergenic contrast agent for intravascular imaging [2,3]. CO2 has a low atomic number and is less dense (more radiolucent) than surrounding structures with less x-ray attenuation, and as such is a negative contrast agent. CO2 often induces pain at time of injection (due to rapid expansion of compressed gas leaving the catheter) and image quality is susceptible to motion degradation. Angiographic images appear uneven and un-sharp due to gas column buoyancy, fragmentation and rapid dissolution in blood that can compromise its utility in lower limb vascular disease assessment, in particular below knees [4]. The risk of CA-AKI/CI-AKI secondary to ICM is dose-dependent [5]. A very small volume of ICM may be used during CO2 angiography to improve diagnostic quality, especially of below knee run-off arteries, and the risk of CA-AKI/CI-AKI is likely small.
The aim of this retrospective study was to evaluate the diagnostic efficacy of CO2 angiogram in infra-popliteal vascular disease of the lower limbs, and the diagnostic benefit of the use of very small volume of iodinated contrast media (ICM) in the below knee run-off arteries.