Gadolinium-enhanced digital subtraction angiography of hemodialysis fistulas: a diagnostic and therapeutic approach.

Abstract

OBJECTIVE:

The aim of our study was to evaluate the feasibility, safety, and potential role of the contrast agent gadoterate meglumine for digital subtraction angiography as a single diagnostic procedure or before percutaneous transluminal angioplasty of malfunctioning native dialysis fistulas.

MATERIALS AND METHODS:

Over a 20-month period, 23 patients (15 women, eight men) with an age range of 42-87 years (mean, 63 years) having end-stage renal insufficiency and with recent hemodialysis fistula surgical placement underwent gadoterate-enhanced digital subtraction angiography with a digital 1024 x 1024 matrix. Opacification was performed on the forearm, arm, and chest with the patient in the supine position using an injection (retrograde, n = 14; anterograde, n = 8; arterial, n = 1) of gadoterate meglumine into the perianastomotic fistula segment at a rate of 3 mL/sec for a total volume ranging from 24 to 32 mL. Percutaneous transluminal angioplasty was performed in three patients and required an additional 8 mL per procedure. Examinations were compared using a 3-step confidence scale and a two-radiologist agreement (Cohen's kappa statistic) for diagnostic and opacification quality. Tolerability was evaluated on the basis of serum creatinine levels and the development of complications.

RESULTS:

No impairment of renal function was found in the 15 patients who were not treated with hemodialysis. Serum creatinine level change varied from -11.9% to 11.6%. All studies were of diagnostic quality. The presence of stenosis (n = 14) or thrombosis (n = 3) in arteriovenous fistulas was shown with good interobserver agreement (kappa = 0.71-0.80) in relation to opacification quality (kappa = 0.59-0.84). No pain, neurologic complications, or allergiclike reactions occurred. Three percutaneous transluminal angioplasty procedures (brachiocephalic, n = 2; radiocephalic, n = 1) were successfully performed.

CONCLUSION:

Gadoterate-enhanced digital subtraction angiography is an effective and safe method to assess causes of malfunction of hemodialysis fistulas. It can also be used to plan and perform percutaneous transluminal angioplasty.

• Authors: Alain-Ferdinand Le Blanche, Marc Tassart, Jean-François Deux, Jérôme Rossert, Jean-Michel Bigot, Frank Boudghene
• Journal: AJR. American journal of roentgenology (AJR Am J Roentgenol) Vol. 179 Issue 4 Pg. 1023-8 (Oct 2002) ISSN: 0361-803X [Print] United States
• PMID: 12239059 (Publication Type: Journal Article)

Chemical References

• Contrast Media
• Organometallic Compounds
• Meglumine
• Gadolinium
• gadoterate meglumine

Topics

• Adult
• Aged
• Aged, 80 and over
• Angiography, Digital Subtraction (adverse effects)
• Angioplasty, Balloon
• Arteriovenous Shunt, Surgical
• Constriction, Pathologic (diagnostic imaging)
• Contrast Media (adverse effects)
• Feasibility Studies
• Female
• Gadolinium (adverse effects)
• Graft Occlusion, Vascular (diagnostic imaging, therapy)
• Humans
• Male
• Meglumine (adverse effects)
• Middle Aged
• Organometallic Compounds (adverse effects)
• Radiography, Interventional
• Renal Dialysis
• Retrospective Studies
• Thrombosis (diagnostic imaging)