Endovascular Coiling in a Patient with Chronic Kidney Disease—A Challenge for Anesthesiologist

Abstract

A 41-year-old male patient, a known case of autosomal dominant polycystic kidney disease (ADPCKD), presented to our institute with right middle cerebral artery aneurysm for which balloon-assisted endovascular coiling was planned. The major comorbidities were hypertension and end-stage renal disease (ESRD) on hemodialysis, twice weekly. Endovascular coiling was performed under general anesthesia, and special precautions were taken with regard to monitoring, fluid management, use of heparin, and contrast agent. The intraoperative and postoperative course was uneventful, and the patient was discharged after 7 days. In this report, various perioperative challenges of patients with chronic renal failure during coiling are discussed along with the measures to prevent the occurrence of contrast-induced nephropathy.

Anesthetic Considerations for a Patient with Autosomal Dominant Polycystic Kidney Disease, Having a Ruptured Intracranial Aneurysm for Endovascular Coiling: A Case Report

“…Mitra et al 10 successfully managed an end-stage renal disease (ESRD) patient with unruptured cerebral aneurysms posted for endovascular coiling by maintaining adequate intravascular volume and avoiding fluid overload. In another report of endovascular coiling of cerebral aneurysm in a patient with ESRD, Samagh et al 11 restricted the volume of heparinized flush solution used by the radiologist, timed the last dialysis 12 to 24 hours prior to the procedure, and used a low volume of iso-osmolar contrast agent, avoiding ionic and high osmolar contrast agents.…”