CO2 AND GADOPENTETATE DIMEGLUMINE AS ALTERNATIVE CONTRAST AGENTS FOR MALFUNCTIONING DIALYSIS GRAFTS AND FISTULAS

Background. Hemodialysis grafts and native fistulas are frequently eva luated angiographically utilizing iodinated contrast material to deter mine the cause of malfunction. Occasionally, patients are not able to receive iodinated contrast material due to a history of previous sever e allergic reaction or concern that iodinated contrast material could worsen renal function requiring premature initiation of permanent dial ysis. We set out to test the feasibility of gadopentetate dimeglumine as an alternative contrast agent in conjunction with carbon dioxide (C O2) angiography in the evaluation and treatment of hemodialysis grafts and native fistulas in patients who have a contraindication to iodina ted contrast material. Methods. Six patients with a malfunctioning hem odialysis graft and native fistula were evaluated. Four patients were successfully evaluated using carbon dioxide and gadopentetate dimeglum ine. Two additional patients underwent balloon angioplasty using gadop entetate dimeglumine alone as the alternative contrast agent. Results. All six patients successfully were evaluated and treated using gadope ntetate dimeglumine either alone or as a supplement to CO2 angiography . Five of these patients had lesions successfully treated using gadope ntetate dimeglumine alone or in combination with CO2 as the angiograph ic contrast agents. One patient underwent a successful diagnostic angi ogram using gadopentetate dimeglumine and CO2 as alternative contrast agents and was subsequently treated with surgical revision. The gadope ntetate dimeglumine angiograms identified the arterial anastomosis and more clearly identified stenotic lesions and venous outflow anatomy c ompared to carbon dioxide angiograms. Conclusion. Gadopentetate dimegl umine is useful as an alternative contrast agent in conjunction with C O2 in patients with malfunctioning hemodialysis grafts and fistulas, w ho have a contraindication to the administration of iodinated contrast material.