Szczurowska A, Banasik M, Kurcz J, Miś M, Nowańska K, Madziarska K, Mazanowska O, Krajewska M, Garcarek J, Guziński M. Intra-arterial computed tomography angiography with ultra-low volume of iodine contrast and stent implantation in transplant renal artery stenosis in terms of contrast-induced kidney injury - a preliminary report.
Pol J Radiol 2020;
85:e174-e177. [PMID:
32419881 PMCID:
PMC7218445 DOI:
10.5114/pjr.2020.94364]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 02/25/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE
Traditional digital subtraction angiography is still regarded as the gold standard in the diagnostics of transplant renal artery stenosis (TRAS). However, this procedure requires a high volume of iodine contrast medium for optimal visualisation of the renal artery. The aim of this study was to analyse both the usefulness and the safety of intra-arterial computed tomography angiography (IA-CTA) with ultra-low-volume iodine contrast administration in the diagnostic and therapeutic management of TRAS in patients with impaired renal transplant function.
MATERIAL AND METHODS
Thirty-three patients with a suspicion of TRAS based on Doppler-ultrasound and clinical setting underwent IA-CTA with ultra-low iodine contrast volume. A special, author-elaborated CTA protocol was used. The volume of 8-18 ml of diluted iodine contrast medium was administered through a catheter with the tip placed 2 cm below the aortic bifurcation.
RESULTS
In six patients the CTA examinations revealed TRAS in three configurations: in the anastomosis, in the trunk (critical and high-grade), or in both sections. Stenoses were treated with primary stenting obtaining favourable anatomical outcome. No intervention-related complications were observed. No contrast-induced acute kidney injury was diagnosed in this study. Mean serum creatinine concentration was 2.93 ± 0.89 mg/dl at the baseline and 2.89 ± 1.73 mg/dl and 2.17 ± 0.51 mg/dl after three and seven days from IA-CTA, respectively.
CONCLUSIONS
Intra-arterial CTA with ultra-low volume of iodine contrast seems to be a safe and reliable diagnostic tool to detect and assess TRAS in the aspect of stent implantation. Application of this imaging modality eliminates the need for a high volume of iodine contrast and thus does not adversely influence renal transplant function.
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