title: Preprocedural evaluation and endovascular treatment of iliofemoral artery disease without contrast media for patients with pre-existing renal insufficiency.
abstract: BACKGROUND
  Generally, both the preprocedural evaluation and endovascular therapy (EVT) for lower limb arteries require contrast media that is harmful for patients with chronic renal insufficiency. In the present study these procedures were performed without using nephrotoxic contrast media in patients with preexisting renal insufficiency and iliofemoral artery disease.
  
  
  RESULTS
  The 36 consecutive patients with chronic renal insufficiency underwent preprocedural evaluation with duplex examination, magnetic resonance angiography (MRA) without contrast media, and plain computed tomography (CT). A total of 51 lesions were treated using intravascular ultrasound (IVUS) without contrast media. The overall technical success was 100% without any complications. Pre- and postprocedural ankle-brachial indices changed from 0.59 ± 0.23 to 0.92 ± 0.14. The mean serum creatinine concentration before and after treatment, and 3 months after treatment did not change (2.1 ± 1.4, 2.0 ± 1.4, and 2.1 ± 1.6 mg/dl, respectively). The overall 3-month survival rate and limb salvage rate was 100%.
  
  
  CONCLUSIONS
  EVT comprising duplex, MRA, and CT for preprocedural evaluation and IVUS-guided procedure is feasible and may avoid intra-arterial contrast injection in selected patients deemed at high risk for renal failure from nephrotoxic contrast material.
authors.affiliation: Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Daizo
authors.initials: D
authors.lastname: Kawasaki
authors.forename: Kenichi
authors.initials: K
authors.lastname: Fujii
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukunaga
authors.forename: Naohiko
authors.initials: N
authors.lastname: Fujii
authors.forename: Motomaru
authors.initials: M
authors.lastname: Masutani
authors.forename: Masaaki Lee
authors.initials: ML
authors.lastname: Kawabata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsujino
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Ohyanagi
authors.forename: Tohru
authors.initials: T
authors.lastname: Masuyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D003251:Constriction, Pathologic; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D003952:Diagnostic Imaging / Q000379:methods; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007564:Japan; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications*; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers; D003287:Contrast Media; D003404:Creatinine