Lower extremity arteriography with use of iodinated contrast material or gadodiamide to supplement CO2 angiography in patients with renal insufficiency

PURPOSE: To determine if the use of nonionic contrast material, as compared to the use of gadodiamide to supplement carbon dioxide angiography in pati ents with peripheral vascular disease (PVD) and chronic renal insufficiency (CRI), results in significant worsening of renal function. MATERIALS AND METHODS: Lower extremity angiographic procedures (diagnostic and diagnostic/intervention) were performed in 40 patients with CRI (baseli ne serum creatinine [Cr] > 1.5 mg/dL) using CO2 alone or CO2 supplemented w ith the use of either nonionic contrast material or gadodiamide (up to 0.4 mmol/kg), Serum creatinine levels were obtained before the procedure and at 48 hours after the procedure, The peak Cr level was also determined for pa tients with a significant (>0.5 mg/dL) Cr elevation. RESULTS: Forty-two lower extremity angiographic procedures (19 diagnostic a nd 23 diagnostic/interventions) were performed in 40 consecutive patients f rom August 1997 to October 1998, with a mean preprocedure Cr of 2.2 mg/dL a nd a mean postprocedure Cr of 2.4 mg/dL. Twenty-five of the 40 patients (63 %) had diabetes mellitus, Fifteen procedures, including six interventions, were performed utilizing CO2 and nonionic contrast material in 15 patients, Six of these 15 patients (40%) demonstrated a Cr increase > 0.5 mg/dL at 4 8 hours. Seven procedures, including two interventions, were performed with CO2 alone in seven patients, No patients in this group demonstrated an inc rease in serum creatinine of greater than 0.5 mg/dL at 48 hours. Twenty pro cedures, including 15 interventions, were performed with CO2 and gadodiamid e in 18 patients. In one of these 20 procedures (5%) there was an increase in Cr > 0.5 mg/dL at 48 hours, The difference in worsening renal function f or the nonionic contrast group (six of 15) compared with the CO2/gadodiamid e group (one of 20) was statistically significant (P = .03). When comparing the use of CO2 and nonionic contrast material versus CO2 alone and with ga dodiamide (six of 15 versus one of 27), the difference is also statisticall y significant (P < .01). The average volume of supplemental contrast materi al was similar in the nonionic contrast material and gadodiamide groups, as was the average volume of supplemental nonionic contrast material in the s ix patients with an increased Cr, CONCLUSION: The use of small volumes of nonionic contrast material to suppl ement CO2 angiography in patients with PVD and CRI can be associated with a significant increased risk of worsening renal function when compared to an giography performed with CO2 alone or CO2 and gadodiamide.