Gadolinium-enhanced digital subtraction angiography of hemodialysis XXXX : a diagnostic and therapeutic approach.

@entity1 @entity8 @entity2548 @entity1559 @entity292 @entity2531 @entity1011 @entity715 @entity850 @entity454
OBJECTIVE: The aim of our study was to evaluate the feasibility, safety, and potential role of the contrast agent gadoterate @entity1559 for digital subtraction angiography as a single diagnostic procedure or before percutaneous transluminal angioplasty of malfunctioning native dialysis @entity292 . MATERIALS AND METHODS: Over a 20-month period, 23 @entity1 (15 @entity1 , eight @entity1 ) with an age range of 42-87 years (mean, 63 years) having @entity454 and with recent hemodialysis @entity292 surgical placement underwent gadoterate-enhanced digital subtraction angiography with a digital 1024 x 1024 matrix. Opacification was performed on the forearm, arm, and chest with the @entity1 in the supine position using an injection (retrograde, n = 14; anterograde, n = 8; arterial, n = 1) of gadoterate @entity1559 into the perianastomotic @entity292 segment at a rate of 3 mL/sec for a total volume ranging from 24 to 32 mL. Percutaneous transluminal angioplasty was performed in three @entity1 and required an additional 8 mL per procedure. Examinations were compared using a 3-step confidence scale and a two-radiologist agreement (Cohen's kappa statistic) for diagnostic and opacification quality. Tolerability was evaluated on the basis of serum @entity1011 levels and the development of complications. RESULTS: No @entity8 was found in the 15 @entity1 who were not treated with hemodialysis. Serum @entity1011 level change varied from -11.9% to 11.6%. All studies were of diagnostic quality. The presence of @entity850 (n = 14) or @entity715 (n = 3) in @entity2548 was shown with good interobserver agreement (kappa = 0.71-0.80) in relation to opacification quality (kappa = 0.59-0.84). No @entity2531 , or allergiclike reactions occurred. Three percutaneous transluminal angioplasty procedures (brachiocephalic, n = 2; radiocephalic, n = 1) were successfully performed. CONCLUSION: Gadoterate-enhanced digital subtraction angiography is an effective and safe method to assess causes of malfunction of hemodialysis @entity292 . It can also be used to plan and perform percutaneous transluminal angioplasty.
