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

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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.

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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.

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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
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  2. Satoshi Kodera
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  4. Junji Kanda
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Correspondence to Naoki Hayakawa.

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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.

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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

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

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