Spinosa D J, Angle J F, Hagspiel K D, Schenk W G, Matsumoto A H
Department of Radiology, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Kidney Int. 1998 Sep;54(3):945-50. doi: 10.1046/j.1523-1755.1998.00047.x.
Hemodialysis grafts and native fistulas are frequently evaluated angiographically utilizing iodinated contrast material to determine the cause of malfunction. Occasionally, patients are not able to receive iodinated contrast material due to a history of previous severe allergic reaction or concern that iodinated contrast material could worsen renal function requiring premature initiation of permanent dialysis. We set out to test the feasibility of gadopentetate dimeglumine as an alternative contrast agent in conjunction with carbon dioxide (CO2) angiography in the evaluation and treatment of hemodialysis grafts and native fistulas in patients who have a contraindication to iodinated contrast material.
Six patients with a malfunctioning hemodialysis graft and native fistula were evaluated. Four patients were successfully evaluated using carbon dioxide and gadopentetate dimeglumine. Two additional patients underwent balloon angioplasty using gadopentetate dimeglumine alone as the alternative contrast agent.
All six patients successfully were evaluated and treated using gadopentetate dimeglumine either alone or as a supplement to CO2 angiography. Five of these patients had lesions successfully treated using gadopentetate dimeglumine alone or in combination with CO2 as the angiographic contrast agents. One patient underwent a successful diagnostic angiogram using gadopentetate dimeglumine and CO2 as alternative contrast agents and was subsequently treated with surgical revision. The gadopentetate dimeglumine angiograms identified the arterial anastomosis and more clearly identified stenotic lesions and venous outflow anatomy compared to carbon dioxide angiograms.
Gadopentetate dimeglumine is useful as an alternative contrast agent in conjunction with CO2 in patients with malfunctioning hemodialysis grafts and fistulas, who have a contraindication to the administration of iodinated contrast material.
血液透析移植物和自体动静脉内瘘常通过使用碘化造影剂进行血管造影评估，以确定功能障碍的原因。偶尔，由于既往有严重过敏反应史，或担心碘化造影剂会使肾功能恶化而需要过早开始永久性透析，患者无法接受碘化造影剂。我们旨在测试钆喷酸葡胺作为替代造影剂联合二氧化碳血管造影在评估和治疗对碘化造影剂有禁忌证的患者的血液透析移植物和自体动静脉内瘘中的可行性。
对6例血液透析移植物和自体动静脉内瘘功能障碍的患者进行评估。4例患者使用二氧化碳和钆喷酸葡胺成功进行了评估。另外2例患者仅使用钆喷酸葡胺作为替代造影剂进行了球囊血管成形术。
所有6例患者均使用钆喷酸葡胺单独或作为二氧化碳血管造影的补充成功进行了评估和治疗。其中5例患者使用钆喷酸葡胺单独或联合二氧化碳作为血管造影造影剂成功治疗了病变。1例患者使用钆喷酸葡胺和二氧化碳作为替代造影剂成功进行了诊断性血管造影，随后接受了手术修复。与二氧化碳血管造影相比，钆喷酸葡胺血管造影更清晰地显示了动脉吻合口、狭窄病变和静脉流出道解剖结构。
对于对碘化造影剂给药有禁忌证的血液透析移植物和内瘘功能障碍患者，钆喷酸葡胺作为联合二氧化碳的替代造影剂是有用的。
