Skip to main content

Advertisement

SpringerLink
Log in

Efficacy and safety of endovascular therapy by diluted contrast digital subtraction angiography in patients with chronic kidney disease

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

This study was performed to evaluate the efficacy and safety of endovascular therapy (EVT) by diluted contrast digital subtraction angiography (DSA) in patients with chronic kidney disease (CKD). Patients with peripheral artery disease (PAD) often have CKD; thus, EVT carries a risk of contrast-induced nephropathy (CIN). Reducing the amount of contrast medium is, therefore, important in these patients. We developed a novel EVT method using DSA with diluted contrast medium. DSA parameters were adjusted for diluted contrast angiography (1:10 dilution), and we defined this technique as low-concentration DSA (LC-DSA). We retrospectively analyzed 122 patients with CKD [estimated glomerular filtration rate (eGFR), < 45 mL/min/1.73 m2] from June 2012 to November 2017 and classified them into two groups: EVT with diluted contrast (LC-DSA group, n = 63) and conventional EVT (control group, n = 59). Patients with aortoiliac lesions and those undergoing hemodialysis were excluded. The primary endpoint was the incidence of CIN as defined by an absolute increase in serum creatinine of ≥ 0.5 mg/dL or relative increase of ≥ 25% 2–5 days after the procedure. The secondary endpoints were worsening renal function (defined as an eGFR reduction of ≥ 25% compared with that before the procedure), the amount of contrast medium used for EVT, freedom from complications related to LC-DSA, and procedural success. The incidence of CIN was significantly lower in the LC-DSA group than control group (0.0% vs. 11.9%, respectively; P = 0.001). The absolute eGFR increase (4.25 ± 4.7 vs. 1.24 ± 6.9, respectively; P = 0.005) and creatinine decrease ( − 0.16 ± 0.2 vs. 0.007 ± 0.34, respectively; P = 0.0078) were greater in the LC-DSA group than control group. Less contrast medium was used in the LC-DSA group than control group (30.0 ± 14.6 vs. 117.9 ± 52.8 mL, respectively; P < 0.0001). There were no differences in the procedural success rate (100% vs. 96.6%, P = 0.23) or complications related to LC-DSA (0.0% vs. 1.7%, P = 0.48). Therefore, we concluded that EVT with diluted contrast DSA reduced the amount of contrast medium and incidence of CIN. This method is effective and safe for treating patients with CKD who have infrainguinal lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Romano G, Briquori C, Quintavalle C, Zanca C, Rivera NV, Colombo A, Condorelli G (2008) Contrast agents and renal cell apoptosis. Eur Heart J 29:2569–2576

    Article  CAS  Google Scholar 

  2. Weisbord SD, Gallagher M, Jneid H, Garcia S, Cass A, Thwin SS, Conner TA, Chertow GM, Bhatt DL, Shunk K, Parikh CR, McFalls EO, Brophy M, Ferguson R, Wu H, Androsenko M, Myles J, Kaufman J, Palevsky PM; PRESERVE Trial Group (2018) Outcomes after angiography with sodium bicarbonate and acetylcysteine. N Engl J Med 378:603–614

    Article  Google Scholar 

  3. Isenbarger DW, Kent SM, O'Malley PG (2003) Meta-analysis of randomized clinical trials on the usefulness of acetylcysteine for prevention of contrast nephropathy. Am J Cardiol 92:1454–1458

    Article  CAS  Google Scholar 

  4. Hawkins IF, Cho KJ, Caridi JG (2009) Carbon dioxide in angiography to reduce the risk of contrast-induced nephropathy. Radiol Clin North Am 47:813–825

    Article  Google Scholar 

  5. Fujihara M, Kawasaki D, Shintani Y, Fukunaga M, Nakama T, Koshida R, Higashimori A, Yokoi Y; CO2 Angiography Registry Investigators (2015) Endovascular therapy by CO2 angiography to prevent contrast-induced nephropathy in patients with chronic kidney disease: a prospective multicenter trial of CO2 angiography registry. Catheter Cardiovasc Interv 85:870–877

  6. Hayakawa N, Kodera S, Ohki N, Kushida S, Morita H, Kanda J, Komuro I (2019) Endovascular therapy using diluted contrast medium for critical limb ischemia in a patient with chronic kidney disease. Int Heart J 60(1):226–230

    Article  Google Scholar 

  7. Alikhani B, Jamali L, Raatschen HJ, Wacker F, Werncke T (2017) Impact of CT parameters on the physical quantities to image quality for two MDCT scanners using ACR accreditation phantom: a phantom study. Radiography 23:202–210

    Article  CAS  Google Scholar 

  8. Spargias K, Alexopoulos E, Kyrzopoulos S, Iokovis P, Greenwood DC, Manginas A, Voudris V, Pavlides G, Buller CE, Kremastinos D, Cokkinos DV (2004) Ascorbic acid prevents contrast-mediated nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. Circulation 110:2837–2842

    Article  CAS  Google Scholar 

  9. Spargias K, Adreanides E, Demerouti E, Gkouziouta A, Manginas A, Pavlides G, Voudris V, Cokkinos DV (2009) Iloprost prevents contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention. Circulation 120:1793–1799

    Article  CAS  Google Scholar 

  10. Marenzi G, Marana I, Lauri G, Assanelli E, Grazi M, Campodonico J, Trabattoni D, Fabbiocchi F, Montorsi P, Bartorelli AL (2003) The prevention of radiocontrast-agent-induced nephropathy by hemofiltration. N Engl J Med 349:1333–1340

    Article  CAS  Google Scholar 

  11. Fung JW, Szeto CC, Chan WW, Kum LC, Chan AK, Wong JT, Wu EB, Yip GW, Chan JY, Yu CM, Woo KS, Sanderson JE (2004) Effect of N-acetylcysteine for prevention of contrast nephropathy in patients with moderate to severe renal insufficiency: a randomized trial. Am J Kidney Dis 43:801–808

    Article  CAS  Google Scholar 

  12. Fan Y, Wei Q, Cai J, Shi Y, Zhang Y, Yao L, Wang X, Lin S, Li Y, Lv J, Zhou B, Du R (2016) Preventive effect of oral nicorandil on contrast-induced nephropathy in patients with renal insufficiency undergoing elective cardiac catheterization. Heart Vessels 31:1776–1782

    Article  Google Scholar 

  13. Hafiz AM, Jan MF, Mori N, Shaikh F, Wallach J, Bajwa T, Allaqaband S (2012) Prevention of contrast-induced acute kidney injury in patients with stable chronic renal disease undergoing elective percutaneous coronary and peripheral interventions: randomized comparison of two preventive strategies. Catheter Cardiovasc Interv 79:929–937

    Article  Google Scholar 

  14. Han B, Li Y, Dong Z, Wan Q, Shen H, Li J, Wei M, Shen C (2018) Diastolic dysfunction predicts the risk of contrast-induced nephropathy and outcome post- emergency percutaneous coronary intervention in AMI patients with preserved ejection fraction. Heart Vessels 33:1149–1158

    Article  Google Scholar 

  15. Mariani J Jr, Guedes C, Soares P, Zalc S, Campos CM, Lopes AC, Spadaro AG, Perin MA, Filho AE, Takimura CK, Ribeiro E, Kalil-Filho R, Edelman ER, Serruys PW, Lemos PA (2014) Intravascular ultrasound guidance to minimize the use of iodine contrast in percutaneous coronary intervention: the MOZART (Minimizing cOntrast utilization With IVUS Guidance in coronary angioplasty) randomized controlled trial. JACC Cardiovasc Interv 7:1287–1293

    Article  Google Scholar 

  16. Iranirad L, Hejazi SF, Sadeghi MS, Jang SA (2017) Efficacy of nicorandil treatment for prevention of contrast-induced nephropathy in high-risk patients undergoing cardiac catheterization: a prospective randomized controlled trial. Cardiol J 24:502–507

    Article  Google Scholar 

  17. Cigarroa RG, Lange RA, Williams RH, Hillis LD (1989) Dosing of contrast material to prevent contrast nephropathy in patients with renal disease. Am J Med 86:649–652

    Article  CAS  Google Scholar 

  18. Laskey WK, Jenkins C, Selzer F, Marroquin OC, Wilensky RL, Glaser R, Cohen HA, Holmes DR Jr; NHLBI Dynamic Registry Investigators (2007) Volume-to-creatinine ratio: a pharmacokinetically based risk factor for prediction of early creatine increase after percutaneous coronary intervention. J Am Coll Cardiol 50:584–590

  19. Joshi SB, Mendoza DD, Steinberg DH, Goldstein MA, Lopez CF, Raizon A, Weissman G, Satler LF, Pichard AD, Weigold WG (2009) Ultra-low-dose intra-arterial contrast injection for iliofemoral computed tomographic angiography. JACC Cardiovasc Imaging 2:1404–1411

    Article  Google Scholar 

  20. Kawasaki D, Fujii K, Fukunaga M, Masutani M, Nakata A, Masuyama T (2012) Safety and efficacy of endovascular therapy with a simple homemade carbon dioxide delivery system in patients with iliofemoral artery disease. Circ J 76:1722–1728

    Article  CAS  Google Scholar 

  21. Palena LM, Diaz-Sandoval LJ, Candeo A, Brigato C, Sultato E, Manzi M (2016) Automated carbon dioxide angiography for the evaluation and endovascular treatment of diabetic patients with critical limb ischemia. J Endovasc Ther 23:40–48

    Article  Google Scholar 

  22. Caridi JG, Hawkins IF (1997) CO2 digital subtraction angiography: potential complications and their prevention. J Vasc Interv Radiol 8:383–391

    Article  CAS  Google Scholar 

  23. Oliva VL, Denbow N, Therasse E, Common AA, Harel C, Giroux MF, Soulez G (1999) Digital subtraction angiography of the abdominal aorta and lower extremities: carbon dioxide versus iodinated contrast material. J Vasc Interv Radiol 10:727–731

    Article  Google Scholar 

  24. Kawasaki D, Tsujino T, Fujii K, Masutani M, Ohyanagi M, Masuyama T (2008) Novel use of ultrasound guidance for recanalization of iliac, femoral, and popliteal arteries. Catheter Cardiovasc Interv 71:727–733

    Article  Google Scholar 

  25. Georges JL, Boueri Z, Mailler B, Nallet O, Millischer D, Faure A, Massiani PF, Belle L, Chapoutot L, Girodet B, Cattan S (2018) Reduction of radiation exposure associated with renewal of the radiologic systems in coronary interventions. Ann Cardiol Angeiol (Paris) 67:334–338

    Article  Google Scholar 

Download references

Acknowledgements

We thank Angela Morben, DVM, ELS, from Edanz Group (https://www.edanzediting.com/ac), for editing a draft of this manuscript.

Funding

This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511, Japan

    Naoki Hayakawa, Satoshi Kodera & Junji Kanda

  2. Department of Cardiovascular Medicine, University of Tokyo Hospital, Tokyo, Japan

    Satoshi Kodera

  3. Department of Radiology, Asahi General Hospital, Chiba, Japan

    Noriyoshi Ohki

Authors
  1. Naoki Hayakawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Satoshi Kodera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Noriyoshi Ohki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Junji Kanda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naoki Hayakawa.

Ethics declarations

Conflict of interest

The authors declare no potential conflicts of interest regarding the research, authorship, and/or publication of this article.

Research ethics

All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hayakawa, N., Kodera, S., Ohki, N. et al. Efficacy and safety of endovascular therapy by diluted contrast digital subtraction angiography in patients with chronic kidney disease. Heart Vessels 34, 1740–1747 (2019). https://doi.org/10.1007/s00380-019-01412-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-019-01412-2

Keywords

Search

Navigation