Gregory J. Nadolski, MD, S. William Stavropoulos, MD

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Presentation transcript:

Contrast alternatives for iodinated contrast allergy and renal dysfunction: Options and limitations Gregory J. Nadolski, MD, S. William Stavropoulos, MD Journal of Vascular Surgery Volume 57, Issue 2, Pages 593-598 (February 2013) DOI: 10.1016/j.jvs.2012.10.009 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Tandem three-way stopcocks with extension tubing and 60-mL syringe used to administer carbon dioxide (CO2) for angiography. B, Filling the syringe with CO2. C, Disconnect syringe from tubing that is connected to the CO2 canister. Close three-way stopcock. The syringe is not ready to connect to the diagnostic catheter. Journal of Vascular Surgery 2013 57, 593-598DOI: (10.1016/j.jvs.2012.10.009) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 Diagnosis of May-Thurner syndrome and treatment using carbon dioxide (CO2). Cavogram and bilateral iliac venogram demonstrate normal right iliac vein (A) and extrinsically compressed left common iliac vein (B). Accurate estimation of vessel size for stent placement can be obtained with CO2. Poststent venogram demonstrates brisk flow into the inferior vena cava with appropriately sized and properly apposed stent in the left common iliac (C). Journal of Vascular Surgery 2013 57, 593-598DOI: (10.1016/j.jvs.2012.10.009) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 Leg arteriogram demonstrating pseudostenosis. A, Left leg arteriogram depicting stenosis in left common femoral artery and proximal left superficial femoral artery (arrows). B, Repeat arteriogram with the patient's leg elevated and with more forceful injection showing the suspected lesion in the common femoral artery was a pseudostenosis, while the stenosis of the superficial femoral artery was overestimated. Both occurred due to poor injection technique and underfilling of the vessel. Journal of Vascular Surgery 2013 57, 593-598DOI: (10.1016/j.jvs.2012.10.009) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 Use of carbon dioxide (CO2) in conjunction with dilute contrast. Aortogram with CO2 identifies single left renal artery (white arrow) and large hypervascular left renal mass (black arrow). Dilute contrast was used for selective renal arteriogram before embolization of the mass (image not shown). Journal of Vascular Surgery 2013 57, 593-598DOI: (10.1016/j.jvs.2012.10.009) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 5 Use of dilute contrast to supplement carbon dioxide (CO2) in upper extremity fistulogram performed in a patient with residual renal function. Retrograde access to the fistula was achieved directed toward arterial anastomosis. The radial artery was selected with a Binkert catheter. A, Fistulogram performed using dilute iodinated contrast material demonstrating two tandem stenoses in the perianastomotic vein (black arrows). B, Postangioplasty fistulogram with dilute iodinated contrast material (ICM) demonstrating no residual stenosis. The remainder of the fistulogram, including central venography, was completed using CO2 (image not shown). Journal of Vascular Surgery 2013 57, 593-598DOI: (10.1016/j.jvs.2012.10.009) Copyright © 2013 Society for Vascular Surgery Terms and Conditions