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MacLeod CA, Gauthier I, Davenport MS, McGrath TA, Khan F, Dos Santos MP, McInnes MDF, Schieda N. Adverse Events Associated with Intra-Arterial Administration of Gadolinium-Based Contrast Agents: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2022; 34:568-577.e10. [PMID: 36464013 DOI: 10.1016/j.jvir.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/08/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To determine the risk of immediate hypersensitivity reactions (HRs), contrast-associated acute kidney injury (CA-AKI), nephrogenic systemic fibrosis (NSF), and gadolinium retention associated with use of intra-arterial gadolinium-based contrast agents (GBCAs). MATERIALS AND METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from 1988 (GBCAs approved for clinical use) to March 2021 for studies reporting adverse events associated with intra-arterial administration of GBCAs. The number of adverse events and GBCA administrations were used to calculate incidence in individual studies, and results across studies were pooled using random-effects meta-analysis. RESULTS There were 72 studies (patients = 1,221) that reported on HR, 59 studies (patients = 1,142) that reported on CA-AKI, and 6 studies (patients = 291) that reported on NSF. No studies reported gadolinium retention as an outcome. Based on 5 events and 1,451 GBCA administrations, the incidence of HR per 100 administrations was 0.95 (95% CI, 0.52-1.51). Based on 90 events and 1,318 GBCA administrations, the incidence of CA-AKI per 100 administrations was 5.94 (95% CI, 3.92-8.34). Based on 7 events and 361 GBCA administrations, the incidence of NSF per 100 Group I GBCA administrations was 4.72 (95% CI, 0.35-13.70). There were no unconfounded NSF events after Group II GBCA administration. CONCLUSIONS HRs to intra-arterial administration of GBCAs are rare, with no serious reactions. Limited data demonstrate a higher-than-expected rate of CA-AKI; however, multiple confounding factors were noted. Thus, any causative link of CA-AKI to GBCA remains controversial. Also, severe physiologic reactions (including life-threatening arrhythmias) during coronary angiography have been reported.
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Affiliation(s)
- Chad A MacLeod
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Isabelle Gauthier
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew S Davenport
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Trevor A McGrath
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Faizan Khan
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Mathew D F McInnes
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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Risk factors for postoperative renal dysfunction following open surgical repair of abdominal aortic aneurysms retrospective analysis. Oncotarget 2017; 8:97749-97757. [PMID: 29228648 PMCID: PMC5716688 DOI: 10.18632/oncotarget.22049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/03/2017] [Indexed: 02/05/2023] Open
Abstract
Objectives To identify the risk factors for postoperative renal dysfunction after open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) and to establish a scoring system. Results The overall 30-day mortality rates were 22.0%(ruptured) vs 2.6% (unruptured), respectively. For the ruptured group, the independent risk factors were hemodynamic instability (P = 0.002) blood loss >1 L (P = 0.041) and preoperative creatinine >150 μmol/L (P < 0.001). By contrast, for the unruptured group, factors were smoking (P = 0.028), blood loss >1 L (P = 0.018), and antihypertensive drugs (P < 0.001). The areas under the curve of the WCRDA scoring system are 0.794 (95% confidence interval (CI) 0.686–0.902, P < 0.001) and 0.811 (95% CI 0.691–0.932, P < 0.001) for the ruptured and unruptured groups, respectively. Conclusions Hemodynamic instability, blood loss >1 L and Hb <90 g/L are independent risk factors for postoperative renal dysfunction following rAAA OSR, whereas smoking, blood loss >1 L, and antihypertensive drugs are independent risk factors. WCRDA performs well in predicting postoperative renal dysfunction. Materials and Methods 287 patients from the Vascular Department of West China Hospital, Sichuan University, who were planned to perform OSR for AAA from November 2003 to January 2017. 274 patients underwent OSR for AAA were finally included in the study. A total of 118 patients had ruptured AAA and 156 unruptured AAA. The patients were divided into the ruptured and unruptured groups. Logistic regression was used to identify the independent risk factors for postoperative renal dysfunction. The receiver operating characteristic curve was used to evaluate the scoring system.
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Alfke H, Geks J, Wagner HJ. [Radiological diagnosis and treatment of acute limb ischemia]. Chirurg 2003; 74:1110-7. [PMID: 14673533 DOI: 10.1007/s00104-003-0759-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Acute limb ischemia is associated with significant morbidity and mortality, despite diagnostic and therapeutic advances. Threatened limbs require immediate imaging in order to determine the subsequent therapeutic procedures. Conventional angiography in the DSA technique still has advantages over CT and MR angiography. In acute arterial occlusions below the femoral bifurcation, endovascular treatment with intra-arterial local thrombolysis or percutaneous thrombectomy is an alternative to open vascular surgical procedures. The following article describes diagnostic and therapeutic strategies for acute limb threat induced by arterial occlusion.
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Affiliation(s)
- H Alfke
- Klinik für Strahlendiagnostik, Klinikum der Philipps-Universität Marburg
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Zeller T, Müller C, Frank U, Bürgelin K, Sinn L, Horn B, Flügel PC, Roskamm H. Gadodiamide as an Alternative Contrast Agent During Angioplasty in Patients With Contraindications to Iodinated Media. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0625:gaaaca>2.0.co;2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zeller T, Müller C, Frank U, Bürgelin K, Sinn L, Horn B, Flügel PC, Roskamm H. Gadodiamide as an alternative contrast agent during angioplasty in patients with contraindications to iodinated media. J Endovasc Ther 2002; 9:625-32. [PMID: 12431148 DOI: 10.1177/152660280200900514] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate gadodiamide as an alternative contrast agent for peripheral and renal angioplasty in patients with contraindications to iodinated contrast media. METHODS Seventeen patients (10 men; mean age 74 years, range 68-83) with contraindication to iodinated contrast media were given gadodiamide as the contrast agent during peripheral and renal intra-arterial digital subtraction angiography (DSA) and subsequent percutaneous interventions (balloon angioplasty, stent placement). RESULTS The mean volume of gadodiamide used was 136 +/- 46 mL (range 60-200). No serious side effects were observed, especially no change in renal or thyroid function; no exanthema or other allergic reactions were noted. In patients without renal artery intervention, serum creatinine at discharge remained unchanged (2.57 +/- 1.43 mg/dL to 2.40 +/- 1.28 mg/dL, p=NS). In patients undergoing angioplasty/stenting of renal artery stenoses, serum creatinine decreased significantly from 3.53 +/- 1.75 mg/dL to 2.36 +/- 1.15 mg/dL (p<0.01). All but 1 intervention was successful. Using a simple scoring system, 2 judges blinded to the contrast agent graded the quality of the peripheral DSAs as "good," whereas renal DSA images were only "sufficient." CONCLUSIONS For patients with contraindications to iodinated materials, gadodiamide may be a suitable alternative for renal or peripheral DSA followed by angioplasty.
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Affiliation(s)
- Thomas Zeller
- Department of Angiology, Herz-Zentrum Bad Krozingen, Germany.
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