Intravascular ultrasound-guided central vein angioplasty and stenting without the use of radiographic contrast agents.
Patients with contraindications to iodinated radiographic contrast agents present a significant challenge during endovascular intervention. A 46-year-old man with end-stage renal disease and a normally functioning left upper extremity arteriovenous fistula presented with severe left arm edema. The patient's history included repeated severe anaphylactoid reactions with severe respiratory distress upon exposure to iodinated contrast. In an attempt to avoid the use of iodinated contrast, angioplasty and stent placement of a severe central venous stenosis were performed using only fluoroscopy and intravascular sonography. In patients unable to receive iodinated contrast secondary to anaphylactoid reactions, intravascular sonography can be used to guide angioplasty and stenting of central venous stenosis.
Matthews
Ray
R
Division of Cardiology, Good Samaritan Hospital, 1225 Wilshire Boulevard, Los Angeles, CA 90017, USA.
Thomas
Joseph
J
D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D005471:Fluoroscopy; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D015607:Stents; D018084:Ultrasonography, Interventional
D003287:Contrast Media