Low-osmolar gadodiamide as alternative contrast agent for diagnostic angiography and angiographic interventions in patients with renal insufficiency

Purpose: To evaluate the benefit and feasibility of gadolinium contrast agents for intra-arterial use in diagnostic and therapeutic angiography in patients with renal insufficiency. Methods: In 15 patients with planned peripheral or renal vascular interventions digital subtraction angiography with intra-arterial administration of gadolinium (gadodiamide n = 14, gadolinium-DTPA n = 1) was performed. Gadolinium was used selectively after peripheral catheter placement, mainly as an adjunct to CO2 (n = 12), to assess the distal run-off vessels or to characterize stenotic lesions, Results: In 14 cases gadolinium yielded good or satisfactory results that were superior to those of CO2 angiography in the femoropopliteal region and calf, but also to the aorto-iliac vessels and the renal arteries. A small amount of iodinated contrast media was administered due to insufficient contrast of gadolinium in one patient. Mean serum creatinine level after angiography (295 +/- 167 mumol/l; range 125 - 764 mumol/l) was not significantly different (p greater than or equal to 0,37) from the initial level (279 +/- 149 pmol/l; range 143 - 728 mumol/l). Conclusion: Gadolinium is a viable alternative contrast agent for digital subtraction angiography and percutaneous transluminal angioplasty in patients with renal insufficiency. It enhances the diagnostic evaluation of stenosis and run-off vessels.