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