The use of carbon dioxide angiography for renal sympathetic denervation: a technical report

Renton, Mary; Hameed, Mohammad A; Dasgupta, Indranil; Hoey, Edward T.D.; Freedman, Jonathan; Ganeshan, Arul

doi:10.1259/bjr.20160311

Cited by 6 publications

(3 citation statements)

References 10 publications

(10 reference statements)

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“…Its clinical use as an angiographic contrast agent was first proposed in the mid-20th century [7] , and it is now often used in place of iodinated contrast agents. Today, CO 2 can be used for the imaging of shunt vessels in patients on hemodialysis [8] , the wedged hepatic venography in the evaluation of portal hypertension [9] , and angiography in patients with renal dysfunction due to chronic kidney disease [10] . Moreover, as the new technique to replace the standard splenic arterial portography, CO 2 wedged arterial splenoportography is introduced to visualize gastric varices associated with splenic vein occlusion [11] .…”

Section: Discussionmentioning

confidence: 99%

Carbon dioxide angiography and arterial embolization could successfully control postpartum uterine hemorrhage for the patient with hypersensitivity to iodine compound

Kawashita

Kaneuchi

Nakayama

et al. 2017

Radiology Case Reports

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Transcatheter arterial embolization has become a common management option for intractable postpartum uterine hemorrhage. Iodinated contrast agents are commonly used for embolotherapy but cannot be used in patients with renal dysfunction or iodine allergy. A 37-year-old woman spontaneously delivered a healthy girl but developed severe postpartum uterine hemorrhage, probably due to placenta accrete. Contrast-enhanced computed tomography revealed extravasation of the iodinated contrast agent into the uterine cavity. The patient subsequently developed allergic reaction to this agent. After recovery from the allergic reaction with appropriate treatment, we performed carbon dioxide angiography and found that the extravasation originated from the right uterine artery. Embolization of the right internal iliac artery was performed, and hemostasis was verified. Based on this experience, we suggest carbon dioxide angiography and arterial embolization can be used for treating intractable postpartum hemorrhage in patients with iodinated contrast media allergy or renal dysfunction.

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Section: Discussionmentioning

confidence: 99%

Carbon dioxide angiography and arterial embolization could successfully control postpartum uterine hemorrhage for the patient with hypersensitivity to iodine compound

Kawashita

Kaneuchi

Nakayama

et al. 2017

Radiology Case Reports

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“…Renal angiography was performed utilizing CO 2 as the sole contrast agent to confirm the renal anatomy prior to performing RSDN [ 19 ]. The procedure was carried out in all patients by two interventional radiologists, both with considerable experience in both CO 2 angiography and RSDN.…”

Section: Methodsmentioning

confidence: 99%

Renal denervation using carbon dioxide renal angiography in patients with uncontrolled hypertension and moderate to severe chronic kidney disease

Hameed

Freedman

Watkin

et al. 2017

Clinical Kidney Journal

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BackgroundChronic kidney disease (CKD) is the most common cause of secondary hypertension. More than half of the patients have uncontrolled hypertension (≥140/90 mmHg on three or more antihypertensive agents at optimum doses). Renal sympathetic denervation (RSDN) has been shown to reduce blood pressure (BP) in patients with resistant hypertension. Although patients with CKD have high sympathetic drive, all major clinical trials have excluded patients with estimated glomerular filtration rates (eGFRs) <45 mL/min/1.73m2 for risk of contrast-induced nephropathy.MethodsIn this pilot study, carbon dioxide (CO2) was used as the sole contrast agent to carry out renal angiography and RSDN in patients with moderate to severe CKD (eGFR 15–44 mL/min/1.73m2) and uncontrolled hypertension.ResultsEleven patients (eight males) underwent RSDN. The median age was 57 years [interquartile range (IQR) 49–66]. The median number of antihypertensives being taken at baseline was 4 (IQR 3–4). No statistically significant difference was observed in serum creatinine in the serial follow-ups until at 6 months[median difference 0.25 mg/dL (IQR 0.09–0.53); P = 0.008]. There was a non-significant reduction in median clinic BP from baseline to 6 months [−14 mmHg (IQR −24–5)] and a significant increase in daytime ambulatory systolic BP [7 mmHg (IQR −2–12); P= 0.045]. A trend towards a serial reduction in albuminuria was observed. Procedure-related complications included a groin haematoma (n = 1) and reported flank (n = 1) and groin pain (n = 1).ConclusionsThis pilot study shows that CO2 renal angiography can be used to perform RSDN in patients with significant renal impairment and may lead to associated improvements in clinic BP and albuminuria.

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“…A promising yet controversial iodinated CM, alternative carbon dioxide is contraindicated in intra-arterial injection above the diaphragm (coronary and brachiocephalic arteries, thoracic aorta). CO 2 is currently used only in diagnostic endovascular procedures below the diaphragm (abdominal aorta, lower limb vessels) through an introduction system (CO 2 mmander) and portable tanks with carbon dioxide [63][64][65] (Table 2).…”

Section: /8mentioning

confidence: 99%

Contrast-induced Acute Kidney Injury: A Contemporary Review

Khilchuk¹,

Власенко²,

Scherbak³

et al. 2018

Int J Ren Dis Ther

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Clinically significant Contrast-Induced Acute Kidney Injury (CIAKI) is a severe complication of interventional contrast-based procedures of all kinds. It involves high morbidity, mortality, social and financial losses. Acute renal damage after coronary angiography or percutaneous coronary intervention may occur in 1-2% of cases in the general population or 50+% of cases with high CIAKI exposure. It is essential to detect high-risk patients with renal damage as a major and frequent CIAKI predisposing factor. There are novel biomarkers with rapid or nearly instant response to acute subclinical contrast-induced renal damage, which are highly valuable in CIAKI diagnosis and for this reason desire deeper clinical research. Despite a number of controversies, prophylactic and therapeutic measures are practically the same in a vast majority of guidelines. An intravenous 0.9% NaCl solution remains the only proven measure in CIAKI prophylaxis and treatment, while the use of other pharmacological approaches still needs more relevant prospective clinical research. The aim of this paper was to review contemporary evidencebased CIAKI data.

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The use of carbon dioxide angiography for renal sympathetic denervation: a technical report

Cited by 6 publications

References 10 publications

Carbon dioxide angiography and arterial embolization could successfully control postpartum uterine hemorrhage for the patient with hypersensitivity to iodine compound

Carbon dioxide angiography and arterial embolization could successfully control postpartum uterine hemorrhage for the patient with hypersensitivity to iodine compound

Renal denervation using carbon dioxide renal angiography in patients with uncontrolled hypertension and moderate to severe chronic kidney disease

Contrast-induced Acute Kidney Injury: A Contemporary Review

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