Abstract

ROCHA, Joana Francisca et al. Diagnosis and treatment of haemodialysis vascular access problems without iodinated contrast: a single-centre experience. Port J Nephrol Hypert [online]. 2017, vol.31, n.3, pp.175-182. ISSN 0872-0169.

Introduction: The use of iodinated contrast angiography in the diagnostic and therapeutic approach to arteriovenous access (AVA) problems is limited by nephrotoxicity and allergic reactions. The use of alternatives such as CO2 or ultrasound guidance has increased over the last few decades. Purpose: To evaluate the results and complications of the diagnostic and therapeutic procedures of AVA performed at our centre without the use of iodinated contrast. Methods: We evaluated retrospectively all patients submitted to endovascular diagnostic and/or therapeutic procedures using CO2 or ultrasound at our hospital between January 2013 and December 2016. Results: 30 procedures were performed in 22 patients: 15 ultrasound-guided angioplasties and 15 CO2 procedures (14 angioplasties and 1 diagnostic angiography). The mean age of patients was 74±10 years (41--94). Most procedures (90%) were performed on proximal arteriovenous fistulas (AVFs) and 3 were performed on distal AVFs. Iodinated contrast was not used because of its potential nephrotoxicity. Ultrasound-guided angioplasty was performed to treat outflow stenoses in the majority (73%) of the cases. The result was favourable in all procedures. One was complicated by venous rupture. Regarding angioplasties with CO2, outflow stenoses were the most treated (38%). The result was favourable in all procedures. Diagnostic angiography with CO2 was performed in a patient with signs of limb venous hypertension and was inconclusive. There were two complications in CO2 procedures: formation of pseudoaneurysm at the place of insertion of the introducer (n=1) and transient headache and nausea (n=1). Three of the patients who underwent angioplasty with CO2 and one patient who underwent ultrasound-guided procedure were submitted to balloon-assisted maturation. Conclusion: In our experience, the use of alternative methods with no iodinated contrast (CO2/ultrasound) in the evaluation and treatment of vascular access problems in patients with renal dysfunction is effective and safe

Keywords : Angiography; carbon dioxide; haemodialysis vascular access; ultrasound guided.

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