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Is contrast as bad as we think? Renal function after angiographic embolization of injured patients
Pantelis Vassiliu1, Jack Sava, Konstantinos G Toutouzas
1Division of Trauma and Critical Care, Keck School of Medicine, University of Southern California, Los Angeles, USA.
Background:
Angiographic embolization (AE) is increasingly used to control bleeding after severe trauma. Serious concerns have been raised about the safety of high-volume i.v. contrast in hypotensive, hypovolemic patients.
Study Design:
In a prospective cohort study, 100 consecutive trauma patients underwent AE for bleeding in the abdomen and pelvis. Serum creatinine (Cr) levels were measured before the procedure and up to 5 days after the procedure. Contrast nephropathy was defined as an increase in Cr levels after AE of more than 25% over the baseline measurement. An average of 248 +/- 59 mL of nonionic, low-osmolality contrast was used in all cases.
Results:
Compared with the baseline, no increase in Cr levels after AE was observed among all patients (1.02 +/- 0.24 versus 0.94 +/- 0.26 mg/dL; p = 0.01) or among subgroups of patients who had any of the following risk factors for renal failure: older than 60 years, Injury Severity Score > or = 15, shock on arrival, renal injury, elevated Cr levels (> or = 1.5 mg/dL) before AE, or administration of a high volume of contrast (> 250 mL). Contrast nephropathy developed in five patients by means of mild Cr elevations. In all of these patients, Cr returned to baseline within 5 days of AE. Renal failure requiring hemodialysis developed at 41 and 55 days after AE in two patients with multiple organ failure who eventually died.
Conclusions:
Administration of nonionic contrast during AE causes mild and transient contrast nephropathy in 5% of severely injured patients. Our study adds additional support for the safety of AE for trauma.