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    Contrast Arteriography: Reasons Not As A Preliminary Screening Tool

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    Sri Hari
    Intra-arterial angiography using iodinated contrast material is the gold standard test for diagnosing renal artery disease but it is invasive, expensive, and carries risks. Digital subtraction angiography allows lower contrast loads but image quality can be poor. Carbon dioxide angiography provides sufficient imaging while avoiding nephrotoxicity from iodinated contrast, though rare fatal complications have been reported.

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    Contrast Arteriography: Reasons Not As A Preliminary Screening Tool

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    Sri Hari
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    Intra-arterial angiography using iodinated contrast material is the gold standard test for diagnosing renal artery disease but it is invasive, expensive, and carries risks. Digital subtraction angiography allows lower contrast loads but image quality can be poor. Carbon dioxide angiography provides sufficient imaging while avoiding nephrotoxicity from iodinated contrast, though rare fatal complications have been reported.

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    Intra-arterial angiography using iodinated contrast material is the gold standard test for diagnosing renal artery disease but it is invasive, expensive, and carries risks. Digital subtraction angiography allows lower contrast loads but image quality can be poor. Carbon dioxide angiography provides sufficient imaging while avoiding nephrotoxicity from iodinated contrast, though rare fatal complications have been reported.

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    15 views3 pages

    Contrast Arteriography: Reasons Not As A Preliminary Screening Tool

    Uploaded by

    Sri Hari
    Intra-arterial angiography using iodinated contrast material is the gold standard test for diagnosing renal artery disease but it is invasive, expensive, and carries risks. Digital subtraction angiography allows lower contrast loads but image quality can be poor. Carbon dioxide angiography provides sufficient imaging while avoiding nephrotoxicity from iodinated contrast, though rare fatal complications have been reported.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
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    Contrast Arteriography

    Intra-arterial angiography remains the gold standard for diagnosing renal


    artery disease

    It is the test against which the results of other tests are compared.

    Combined diagnostic and therapeutic procedure (angioplasty and arterial stents)


    has allowed angiography to become a

    Reasons not as a preliminary screening tool

     Expensive test that cannot be done on an outpatient basis.


     Invasive test using ionizing radiation
     Requires arterial puncture, manipulation of arterial catheters
     Injection of iodinated contrast material.

    Complications of arterial puncture and manipulation include


    Bleeding, hematoma, dissection, thrombosis, and distal embolization of
    atherosclerotic plaque, as well as cholesterol embolization.

    Iodinated contrast material -


     Risk of allergic reaction and volume overload.

     Transient impairment of renal function, especially in patients with preexisting


    renal insufficiency and in diabetic patients.

     Decreasing the contrast load through digital post processing

     Use of contrast agents with decreased nephrotoxicity, such as carbon dioxide


    or gadodiamide

    Digital subtraction angiography (DSA)


     Has allowed reduction of the contrast load with a concomitant reduction in
    catheter size.

     Spatial resolution of DSA is lower than that of conventional angiography, the


    contrast resolution of DSA is superior.

     The ability to subtract bone and soft tissue with DSA is an important advantage
    IV-DSA Disadvantages

     Need for a large contrast material volume

     Frequent need for central venous catheters to deliver this large volume

     Poor image quality owing to overlying visceral arteries

     Frequent uninterpretable studies

     Poor opacification, especially in elderly patients or those with cardiac


    dysfunction

    Carbon dioxide DSA:

    Effort to reduce contrast nephrotoxicity from iodinated contrast material.

    An injected bolus of carbon dioxide displaces blood from the vessels to be


    imaged

    Provides sufficient contrast for adequate imaging using DSA technology and
    post processing enhancement.

    ADVANTAGES:

     The injected carbon dioxide is cleared by the lungs without deleterious effects.

     No effect on renal function, Ideal for use in patients with renal insufficiency.

     Non allergenic, cheap, and presents no problems with fluid overload.

     Smaller softer arterial catheters can be used for injection, minimizing trauma
    to the arterial walls.

     Also provide information that is not visualized using standard iodinated contrast
    material, including small arteriovenous shunts, small tumor vessels, and minute
    amounts of arterial bleeding

    Overall accuracy of carbon dioxide DSA was 97%


    Fatal complications - Rhabdomyolysis and intestinal infarction reported

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