Gadolinium-enhanced digital subtraction angiography of hemodialysis fistulas: a diagnostic and therapeutic approach.
OBJECTIVE
The aim of our study was to evaluate the feasibility, safety, and potential role of the contrast agent gadoterate meglumine for digital subtraction angiography as a single diagnostic procedure or before percutaneous transluminal angioplasty of malfunctioning native dialysis fistulas.


METHODS
Over a 20-month period, 23 patients (15 women, eight men) with an age range of 42-87 years (mean, 63 years) having end-stage renal insufficiency and with recent hemodialysis fistula 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 patient in the supine position using an injection (retrograde, n = 14; anterograde, n = 8; arterial, n = 1) of gadoterate meglumine into the perianastomotic fistula 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 patients 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 creatinine levels and the development of complications.


RESULTS
No impairment of renal function was found in the 15 patients who were not treated with hemodialysis. Serum creatinine level change varied from -11.9% to 11.6%. All studies were of diagnostic quality. The presence of stenosis (n = 14) or thrombosis (n = 3) in arteriovenous fistulas was shown with good interobserver agreement (kappa = 0.71-0.80) in relation to opacification quality (kappa = 0.59-0.84). No pain, neurologic complications, or allergiclike reactions occurred. Three percutaneous transluminal angioplasty procedures (brachiocephalic, n = 2; radiocephalic, n = 1) were successfully performed.


CONCLUSIONS
Gadoterate-enhanced digital subtraction angiography is an effective and safe method to assess causes of malfunction of hemodialysis fistulas. It can also be used to plan and perform percutaneous transluminal angioplasty.
Le Blanche
Alain-Ferdinand
AF
Department of Radiology, Tenon University Hospital, 4 rue de la Chine, F-75970 Paris Cedex 20, France.
Tassart
Marc
M
Deux
Jean-François
JF
Rossert
Jérôme
J
Bigot
Jean-Michel
JM
Boudghene
Frank
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000009:adverse effects; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005682:Gadolinium / Q000009:adverse effects; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008297:Male; D008536:Meglumine / Q000009:adverse effects; D008875:Middle Aged; D009942:Organometallic Compounds / Q000009:adverse effects; D015641:Radiography, Interventional; D006435:Renal Dialysis; D012189:Retrospective Studies; D013927:Thrombosis / Q000000981:diagnostic imaging
D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; D005682:Gadolinium; C072417:gadoterate meglumine