Upper extremity digital subtraction venography with gadoterate meglumine before fistula creation for hemodialysis.
BACKGROUND
The purpose of this study was to evaluate the feasibility, safety, and potential role of gadoterate meglumine (Gd-DOTA) as a contrast agent for upper extremity venography before the creation of an arteriovenous fistula (AVF) for nondialyzed renal insufficiency patients.


METHODS
Over a 16-month period, 50 venographies were performed on end-stage renal insufficiency patients, using Gd-DOTA as a contrast agent on a high-resolution digital subtraction angiography system. Three sequences were performed on forearm, arm, and chest at 3 mL/sec for a total of 35 mL of Gd-DOTA. Examinations were reviewed by two radiologists for diagnostic and opacification quality. Tolerance was evaluated on the evolution of serum creatinine levels and occurrence of pain during injection.


RESULTS
Good interobserver correlation was obtained in evaluating the feasibility of AVF creation by vein segment (0.64 < kappa < 0.88) and in relationship to opacification quality (0.62 to 0.87). No deterioration in renal function (creatinine level before and after) or pain was observed. Twenty-six patients underwent surgical creation of brachiobasilic (N = 8), brachiocephalic (N = 8), radiocephalic (N = 8), and cubitocephalic (N = 1) fistulas or insertion of a polytetrafluoroethylene (PTFE) graft (N = 1). Seventeen were awaiting AVF or were on peritoneal dialysis. Two died before surgery for reasons unconnected with the venography.


CONCLUSIONS
Venography with Gd-DOTA is an effective and safe technique in planning AVFs for renal insufficiency patients.
Department of Radiology, Hôpital Tenon, Paris, France.
O
O
Geoffroy
M
M
Tassart
A F
AF
Le Blanche
A
A
Khalil
V
V
Duédal
J
J
Rossert
J M
JM
Bigot
F P
FP
Boudghène
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D003201:Computers; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009942:Organometallic Compounds; D010690:Phlebography; D011138:Polytetrafluoroethylene; D006435:Renal Dialysis; D013382:Subtraction Technique
D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; D011138:Polytetrafluoroethylene; C072417:gadoterate meglumine