Hayakawa Naoki, Kodera Satoshi, Ohki Noriyoshi, Kushida Syunichi, Morita Hiroyuki, Kanda Junji, Komuro Issei
Department of Cardiovascular Medicine, Asahi General Hospital.
Department of Cardiovascular Medicine, The University of Tokyo Hospital.
Int Heart J. 2019 Jan 25;60(1):226-230. doi: 10.1536/ihj.18-125. Epub 2018 Nov 20.
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 m. 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.
很大比例的严重肢体缺血患者同时患有慢性肾脏病（CKD）。然而，血管内治疗（EVT）在CKD患者中可能存在问题。因此，我们开发了一种使用稀释造影剂（低浓度数字减影血管造影，即低浓度DSA）进行数字减影血管造影（DSA）的EVT方法，其中针对稀释造影血管造影（1:10稀释）调整了DSA参数。在此，我们报告一例88岁患有足部伤口和严重CKD的女性病例。她的估算肾小球滤过率为7.9毫升/分钟/1.73平方米。因此，采用低浓度DSA进行了EVT。对照血管造影显示胫前动脉和胫后动脉完全闭塞以及腓动脉严重狭窄。对膝下（BTK）病变进行球囊扩张的EVT使伤口获得了充足的血流。使用1:10稀释造影剂获得了质量足够的血管造影图像以及可见的伤口充血。由于仅需要20毫升造影剂，肾功能得以保留。在该CKD患者中，使用稀释造影剂的DSA进行EVT被证明是一种有效的BTK干预措施。
