title: CO2 and gadopentetate dimeglumine as alternative contrast agents for malfunctioning dialysis grafts and fistulas.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Spinosa
authors.forename: J F
authors.initials: JF
authors.lastname: Angle
authors.forename: K D
authors.initials: KD
authors.lastname: Hagspiel
authors.forename: W G
authors.initials: WG
authors.lastname: Schenk
authors.forename: A H
authors.initials: AH
authors.lastname: Matsumoto
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D002245:Carbon Dioxide; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*
chemical_list: D003287:Contrast Media; D002245:Carbon Dioxide; D019786:Gadolinium DTPA