Is contrast as bad as we think? Renal function after angiographic embolization of injured patients.
BACKGROUND
Angiographic embolization (AE) is increasingly used to control bleeding after severe trauma. Serious concerns have been raised about the safety of high-volume i.v. contrast in hypotensive, hypovolemic patients.


METHODS
In a prospective cohort study, 100 consecutive trauma patients underwent AE for bleeding in the abdomen and pelvis. Serum creatinine (Cr) levels were measured before the procedure and up to 5 days after the procedure. Contrast nephropathy was defined as an increase in Cr levels after AE of more than 25% over the baseline measurement. An average of 248 +/- 59 mL of nonionic, low-osmolality contrast was used in all cases.


RESULTS
Compared with the baseline, no increase in Cr levels after AE was observed among all patients (1.02 +/- 0.24 versus 0.94 +/- 0.26 mg/dL; p = 0.01) or among subgroups of patients who had any of the following risk factors for renal failure: older than 60 years, Injury Severity Score > or = 15, shock on arrival, renal injury, elevated Cr levels (> or = 1.5 mg/dL) before AE, or administration of a high volume of contrast (> 250 mL). Contrast nephropathy developed in five patients by means of mild Cr elevations. In all of these patients, Cr returned to baseline within 5 days of AE. Renal failure requiring hemodialysis developed at 41 and 55 days after AE in two patients with multiple organ failure who eventually died.


CONCLUSIONS
Administration of nonionic contrast during AE causes mild and transient contrast nephropathy in 5% of severely injured patients. Our study adds additional support for the safety of AE for trauma.
Vassiliu
Pantelis
P
Division of Trauma and Critical Care, Keck School of Medicine, University of Southern California, Los Angeles, USA.
Sava
Jack
J
Toutouzas
Konstantinos G
KG
Velmahos
George C
GC
D000005:Abdomen / Q000098:blood supply*; D000007:Abdominal Injuries / Q000628:therapy; D000328:Adult; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D004621:Embolization, Therapeutic; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D007472:Iohexol / Q000009:adverse effects*; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000098:blood supply* / Q000293:injuries; D015641:Radiography, Interventional; D012307:Risk Factors
D003287:Contrast Media; D007472:Iohexol; D003404:Creatinine