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Contrast nephropathy in lower limb angiography.
Paul Srodon1, Matthew Matson, Robert Ham
1Department of Vascular Surgery, Royal London Hospital, London, UK.
Annals of the Royal College of Surgeons of England
|July 2, 2003
Summary
Contrast nephropathy occurred in 8% of lower limb angiograms, particularly in acute limb ischemia cases. Adhering to precautions and considering alternatives is crucial for patients with renal impairment.
Area of Science:
- Radiology
- Nephrology
- Cardiovascular Medicine
Background:
- Contrast nephropathy is a significant risk following angiographic procedures.
- Patients with pre-existing renal impairment are particularly vulnerable.
Purpose of the Study:
- To determine the incidence of contrast nephropathy after lower limb angiograms and angioplasties.
- To identify risk factors and outcomes associated with contrast nephropathy.
Main Methods:
- Retrospective review of 302 lower limb angiogram/angioplasty procedures.
- Serum creatinine monitored 1 and 3 days post-procedure; contrast nephropathy defined as a 25% creatinine increase.
- Exclusion of dialysis patients; analysis of 267 patients with 224 diagnostic and 78 interventional procedures.
Main Results:
- Contrast nephropathy occurred in 8% of cases (15/191), with a higher incidence in acute limb-threatening ischemia.
- Of affected patients, 11 were on nephrotoxic drugs and 9 had renal impairment; precautions were taken in only 2 cases.
- Mortality was 1% from renal failure; 3 deaths were directly attributed to contrast nephropathy.
Conclusions:
- Standard precautionary measures for contrast nephropathy are essential.
- Alternative imaging modalities should be considered for high-risk patients, especially those with renal impairment and comorbidities.