Carbon dioxide Angiography-Guided Renal-Related Interventions in Patients with Takayasu Arteritis and Renal Insufficiency

Background

Use of iodinated contrast agents for angiography in patients with renal insufficiency risks further deterioration of renal function and its adverse sequelae.

Objective

To study the effectiveness and safety of carbon dioxide (CO₂) angiography in guiding percutaneous renal-related interventions in patients with Takayasu arteritis and renal insufficiency.

Methods

Data on CO₂ angiography-guided interventions were obtained from a 23-year database of 692 Takayasu arteritis patients who underwent percutaneous interventions and were analyzed retrospectively. Follow-up data were also obtained. The CO₂ angiography system used was developed in-house and was pressure-driven.

Results

Seven patients (6 female, age 16–59 years, baseline serum creatinine 1.62–4.55 mg/dl, estimated glomerular filtration rate 12.2–36.9 ml/min/1.73 m²) underwent CO₂ angiography-guided interventions: five underwent angioplasty or stenting to treat six stenotic/occluded renal arteries, one underwent extensive endovascular repair for spontaneous focal abdominal aortic dissection with false lumen aneurysm and aorto-iliac true lumen narrowing, and one underwent balloon dilatation of previously deployed aortic stents used to treat aortic occlusion at two levels. Follow-up (median 5 years, range 2 months–16 years) was obtained in all patients. All the procedures were successful and resulted in relief of symptoms, better blood pressure control, improvement in left ventricular systolic function and recovery or stabilization of renal function. There were no early or late complications related to CO₂ angiography. Three renal lesions that had restenosis at follow-up were managed successfully by repeat intervention.

Conclusion

CO₂ angiography-guided renal-related interventions are effective and safe in patients with Takayasu arteritis and renal insufficiency; they significantly improve the care of such patients.