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Published on: September 22, 2020
Endovascular Therapy Using Diluted Contrast Medium for Critical Limb Ischemia in a Patient with Chronic Kidney
Naoki Hayakawa1, Satoshi Kodera1,2, Noriyoshi Ohki3
1Department of Cardiovascular Medicine, Asahi General Hospital.
Insights
Endovascular therapy (EVT) for critical limb ischemia in chronic kidney disease (CKD) patients can be challenging. A novel low-concentration digital subtraction angiography (DSA) technique effectively treated below-the-knee lesions while preserving renal function.
Area of Science:
- Vascular Surgery
- Nephrology
- Radiology
Background:
- Critical limb ischemia (CLI) frequently coexists with chronic kidney disease (CKD).
- Standard endovascular therapy (EVT) poses risks for CKD patients due to contrast medium administration.
- Developing safer EVT techniques for CLI in CKD is crucial.
Observation:
- An 88-year-old woman with severe CKD (eGFR 7.9 mL/min/1.73 m²) presented with CLI and a foot wound.
- She underwent EVT using a novel low-concentration digital subtraction angiography (DSA) technique with 1:10 diluted contrast medium.
- Angiography revealed below-the-knee arterial occlusions and stenosis.
Findings:
- The low-concentration DSA technique provided sufficient angiographic quality for successful EVT.
- Balloon angioplasty of below-the-knee lesions restored adequate arterial flow.
- The procedure required only 20 mL of contrast medium, preserving renal function.
Implications:
- Low-concentration DSA is a viable and renal-sparing EVT approach for CLI patients with severe CKD.
- This technique may improve outcomes for a vulnerable patient population.
- Further studies are warranted to validate this method in a larger cohort.
Abstract:
A high percentage of patients with critical limb ischemia have concurrent chronic kidney disease (CKD). However, endovascular therapy (EVT) can be problematic in CKD patients. Thus, we developed a method of EVT using digital subtraction angiography (DSA) with diluted contrast medium (low-concentration DSA), wherein DSA parameters were adjusted for diluted contrast angiography (1:10 dilution). Herein, we report the case of an 88-year-old woman with a foot wound and severe CKD. Her estimated glomerular filtration rate was 7.9 mL/minute/1.73 m2. Therefore, EVT was performed with low-concentration DSA. Control angiography revealed total occlusion of the anterotibial and posterotibial arteries as well as severe stenosis of the peroneal artery. EVT with ballooning of the below-the-knee (BTK) lesions resulted in sufficient flow to the wound. Angiographic images of sufficient quality and visible wound blush were obtained with 1:10 diluted contrast medium. Because only 20 mL of contrast medium was required, renal function was preserved. EVT using DSA with diluted contrast medium was shown to be an effective BTK intervention in this CKD patient.
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