Upper extremity digital subtraction venography with gadoterate meglumine before fistula creation for hemodialysis

Background. The purpose of this study was to evaluate the feasibility, safe ty, and potential role of gadoterate meglumine (Gd-DOTA) as a contrast agen t for upper extremity venography before the creation of an arteriovenous fi stula (AVF) for nondialyzed renal insufficiency patients. Methods. Over a 16-month period, 50 venographies were performed on end-stag e renal insufficiency patients, using Gd-DOTA as a contrast agent on a high -resolution digital subtraction angiography system. Three sequences were pe rformed on forearm, arm, and chest at 3 mL/sec for a total of 35 mt of Gd-D OTA. Examinations were reviewed by two radiologists for diagnostic and opac ification quality. Tolerance was evaluated on the evolution of serum creati nine levels and occurrence of pain during injection. Results. Good interobserver correlation was obtained in evaluating the feas ibility of AVF creation by vein segment (0.64 < <kappa> < 0.88) and in rela tionship to opacification quality (0.62 to 0.87). No deterioration in renal function (creatinine level before and after) or pain was observed. Twenty- six patients underwent surgical creation of brachiobasilic (N = 8), brachio cephalic (N = 8), radiocephalic (N = 8), and cubito-cephalic (N = 1) fistul as or insertion of a polytetrafluoroethylene (PTFE) graft (N = 1). Seventee n were awaiting AVF or were on peritoneal dialysis. Two died before surgery for reasons unconnected with the venography. Conclusions. Venography with Gd-DOTA is an effective and safe technique in planning AVFs for renal insufficiency patients.