Low-contrast medium doses for ultrasound imaging during renal revascularization by PTA-stenting.
BACKGROUND
To evaluate the incidence of progressive renal damage in patients with chronic renal insufficiency and renal-artery stenosis undergoing percutaneous transluminal angioplasty and stenting (PTA-stenting), color Doppler ultrasound (CDU)-guided, a procedure requiring low-contrast medium doses, or digital subtraction angiography were compared.


METHODS
Thirty patients with renal artery stenosis and severe renal insufficiency underwent PTA-stenting for revascularization, 15 patients with CDU guidance and 15 patients with standard selective digital subtraction angiography (SDSA). Serum creatinine (Cr) concentrations were compared in the two groups at 6 days and 12 months after revascularization.


RESULTS
The stents were properly positioned and resolved the renal artery stenosis. None of the patients who underwent ultrasound-guided PTA-stenting had significantly increased Cr values (>50% or >1 mg/dL) at 6 days after surgery (95% confidence interval (95% CI), 0-21.8); and none had progressive chronic renal insufficiency at 12 months. Conversely, six of the 15 patients in the group who underwent PTA-stenting with standard SDSA had significantly increased Cr values at 6 days (95% CI, 16.3-67.7) and two patients had progressive chronic renal insufficiency at 12 months.


CONCLUSIONS
Our results suggest that PTA-stenting under CDU guidance, a procedure requiring low-contrast medium doses, is suitable for patients with severe renal dysfunction and especially for those with diabetes mellitus undergoing percutaneous renal revascularization.
Cianci
Rosario
R
School of Nephrology, University of Rome La Sapienza, Rome, Italy. caincirosario@tin.it
Lavini
Raffaella
R
Letizia
Claudio
C
Zaccaria
Alvaro
A
Manfredini
Paolo
P
Cerroni
Franca
F
Ciano
Giuseppe
G
Clemenzia
Gianfranco
G
Coen
Giorgio
G
D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D015331:Cohort Studies; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000628:therapy*; D012079:Renal Circulation / Q000502:physiology; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015607:Stents; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D014654:Vascular Patency / Q000502:physiology
D003287:Contrast Media