Safety of Limited Supplemental Iodinated Contrast Administration in Azotemic Patients Undergoing CO 2 Angiography

Abstract

Purpose:

To determine if limited doses of iodinated contrast significantly worsen the underlying renal insufficiency that had warranted the use of CO₂ for diagnostic angiography.

Methods:

The records of 122 consecutive patients who had undergone CO₂ angiography for peripheral vascular disease at our institution over a 5-year period were reviewed. The volume and type of iodinated contrast and the volume of CO₂ administered were recorded. Serum creatinine measurements obtained before angiography and from 2 to 3 days after angiography were recorded.

Results:

One hundred patients had pre-angiography and post-angiography creatinine levels available for analysis (51 CO₂ only, 49 CO₂ with iodinated contrast). The average pre-treatment creatinine level was 2.8±1.5 mg/dL (range 1.8–6.6) for the CO₂ only group and 3.0±1.4 mg/dL (range 1.8–8.2) for the CO₂ plus iodinated contrast group (p=0.46). After angiography, the mean change in creatinine was +0.17±0.87 mg/dL for the CO₂ only group and +0.03±0.98 mg/dL in the CO₂ plus contrast group (p=0.27). Complications included 1 patient with a failing renal transplant who received iodinated contrast and ultimately required return to hemodialysis. A second patient had a transient 1-mg/dL rise of creatinine but did not require dialysis.

Conclusions:

This study supports the relative safety of CO₂ angiography with the limited used of iodinated contrast supplementation for diagnostic studies or interventions in azotemic patients with peripheral vascular disease.