Renal insufficiency: Usefulness of gadodiamide-enhanced renal angiography to supplement CO2-enhanced renal angiography for diagnosis and percutaneoustreatment

PURPOSE: To determine whether gadodiamide is a safe and useful angiographic contrast agent for help in diagnosis and percutaneous treatment of renal a rtery stenosis in patients with renal insufficiency. MATERIALS AND METHODS: Diagnostic renal angiography and percutaneous renal interventions were performed by using gadodiamide (total dose, 0.3 mmol/kg) and CO2 as intraarterial contrast agents in 25 procedures in 24 patients w ith renal insufficiency. Serum creatinine levels were obtained within 24 ho urs before and at 24 and 48 hours after the procedure. Increases in serum c reatinine of more than 44 mu mol/L were considered clinically important. Ga dodiamide-enhanced angiograms were compared with CO2-enhanced angiograms. RESULTS: In 23 (92%) of 25 procedures, there was no increase in serum creat inine level at 48 hours. One patient with acute and chronic rejection of a renal transplant and one with evidence of cholesterol embolization had a cl inically important increase in serum creatinine level at 48 hours. No marke d increase in creatinine level was observed in patients with relatively low baseline levels (n = 19). Gadodiamide-enhanced angiograms appeared to be b etter than CO2-enhanced angiograms for help in identifying renal artery occ lusions, visualizing renal vessels incompletely filled with CO2, and determ ining the progress of intervention. CONCLUSION: Gadodiamide appears to be a safe and useful intraarterial contr ast agent in patients with renal insufficiency and can be used to supplemen t or confirm CO2-enhanced angiographic findings.