HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Spinosa, D. J. Articles by Ayers, C. Search for Related Content PubMed PubMed Citation Articles by Spinosa, D. J. Articles by Ayers, C.

Renal Insufficiency: Usefulness of Gadodiamide-enhanced Renal Angiography to Supplement CO₂-enhanced Renal Angiography for Diagnosis and Percutaneous Treatment

¹ Departments of Radiology (D.J.S., A.H.M., J.F.A., K.D.H.)
² Internal Medicine, Division of Cardiovascular Medicine (C.A.), Box 170, University of Virginia Health Sciences Center, Charlottesville, VA 22908
³ Department of Radiology, St Vincent's Hospital, Toledo, Ohio (J.K.M.).

View larger version (175K): [in a new window]   Figure 1a. (a) CO2-enhanced angiogram shows a patent right renal artery with suboptimal demonstration of the right renal artery origin (arrow). The left renal artery is not clearly depicted. (b) Gadodiamide-enhanced abdominal aortogram demonstrates a patent right renal artery with better definition of the right renal artery origin (straight arrow). Proximal occlusion (curved arrow) of the left main renal artery is clearly depicted.

View larger version (164K): [in a new window]   Figure 1b. (a) CO2-enhanced angiogram shows a patent right renal artery with suboptimal demonstration of the right renal artery origin (arrow). The left renal artery is not clearly depicted. (b) Gadodiamide-enhanced abdominal aortogram demonstrates a patent right renal artery with better definition of the right renal artery origin (straight arrow). Proximal occlusion (curved arrow) of the left main renal artery is clearly depicted.

View larger version (171K): [in a new window]   Figure 2a. (a) CO2-enhanced abdominal aortogram demonstrates a patent right renal artery with the suggestion of narrowing (straight arrow) in the proximal portion of the right main renal artery. The left main renal artery is incompletely filled (curved arrow). (b) Gadodiamide-enhanced abdominal aortogram demonstrates widely patent right renal artery with better depiction of the proximal segment of this vessel (straight arrow). In comparison with a, the left renal artery (curved arrow) is better demonstrated.

View larger version (154K): [in a new window]   Figure 2b. (a) CO2-enhanced abdominal aortogram demonstrates a patent right renal artery with the suggestion of narrowing (straight arrow) in the proximal portion of the right main renal artery. The left main renal artery is incompletely filled (curved arrow). (b) Gadodiamide-enhanced abdominal aortogram demonstrates widely patent right renal artery with better depiction of the proximal segment of this vessel (straight arrow). In comparison with a, the left renal artery (curved arrow) is better demonstrated.

View larger version (154K): [in a new window]   Figure 3a. (a) CO2-enhanced right iliac angiogram demonstrates underfilling (straight arrow) of the right external iliac artery proximal to the transplant artery (curved arrow). (b) Gadodiamide-enhanced right iliac arteriogram demonstrates the iliac artery (straight arrow) to be widely patent proximal to the renal transplant artery (curved arrow).

View larger version (135K): [in a new window]   Figure 3b. (a) CO2-enhanced right iliac angiogram demonstrates underfilling (straight arrow) of the right external iliac artery proximal to the transplant artery (curved arrow). (b) Gadodiamide-enhanced right iliac arteriogram demonstrates the iliac artery (straight arrow) to be widely patent proximal to the renal transplant artery (curved arrow).

View larger version (127K): [in a new window]   Figure 4a. (a) Selective CO2-enhanced right renal arteriogram demonstrates a patent renal artery; however, the proximal (straight arrow) and distal (curved arrow) portions of this main renal artery are difficult to evaluate due to overlying colonic bowel gas and stool. (b) Selective gadodiamide-enhanced right renal arteriogram clearly depicts the main renal artery along its entire course, including the proximal (solid straight arrow) and distal (curved arrow) portions and the intrarenal segmental branches (open arrows).

View larger version (130K): [in a new window]   Figure 4b. (a) Selective CO2-enhanced right renal arteriogram demonstrates a patent renal artery; however, the proximal (straight arrow) and distal (curved arrow) portions of this main renal artery are difficult to evaluate due to overlying colonic bowel gas and stool. (b) Selective gadodiamide-enhanced right renal arteriogram clearly depicts the main renal artery along its entire course, including the proximal (solid straight arrow) and distal (curved arrow) portions and the intrarenal segmental branches (open arrows).

View larger version (166K): [in a new window]   Figure 5a. (a) Selective gadodiamide-enhanced left renal arteriogram demonstrates a filling defect (arrow) at the tip of the catheter, raising concern for an intraluminal thrombus. (b) Gadodiamide-enhanced left renal arteriogram obtained after thrombolysis and percutaneous balloon angioplasty of the origin and proximal portion of the left renal artery demonstrates a persistent filling defect (arrow), which represents thrombus, residual plaque material, or both. (c) Gadodiamide-enhanced left renal arteriogram obtained after percutaneous stent insertion in the left renal artery origin and proximal segment demonstrates a widely patent left renal artery (arrow).

View larger version (177K): [in a new window]   Figure 5b. (a) Selective gadodiamide-enhanced left renal arteriogram demonstrates a filling defect (arrow) at the tip of the catheter, raising concern for an intraluminal thrombus. (b) Gadodiamide-enhanced left renal arteriogram obtained after thrombolysis and percutaneous balloon angioplasty of the origin and proximal portion of the left renal artery demonstrates a persistent filling defect (arrow), which represents thrombus, residual plaque material, or both. (c) Gadodiamide-enhanced left renal arteriogram obtained after percutaneous stent insertion in the left renal artery origin and proximal segment demonstrates a widely patent left renal artery (arrow).

View larger version (159K): [in a new window]   Figure 5c. (a) Selective gadodiamide-enhanced left renal arteriogram demonstrates a filling defect (arrow) at the tip of the catheter, raising concern for an intraluminal thrombus. (b) Gadodiamide-enhanced left renal arteriogram obtained after thrombolysis and percutaneous balloon angioplasty of the origin and proximal portion of the left renal artery demonstrates a persistent filling defect (arrow), which represents thrombus, residual plaque material, or both. (c) Gadodiamide-enhanced left renal arteriogram obtained after percutaneous stent insertion in the left renal artery origin and proximal segment demonstrates a widely patent left renal artery (arrow).

View larger version (184K): [in a new window]   Figure 6a. (a) CO2-enhanced abdominal aortogram demonstrates poor opacification (arrow) of the proximal portion of the left renal artery. However, the incomplete filling of the vessels is suggestive of a high-grade stenosis. (b) CO2-enhanced left renal arteriogram obtained after balloon angioplasty of the proximal left renal artery shows that marked residual narrowing (arrow) remains. It is difficult to determine whether the narrowing represents residual plaque, dissection, or thrombus. (c) Gadodiamide-enhanced angiogram better defines the residual stenosis and filling defect along the inferior surface, which are consistent with residual plaque and an intimal flap (arrow). (d) Gadodiamide-enhanced left renal arteriogram obtained after percutaneous stent placement demonstrates a well-positioned stent and patent left renal artery (arrow).

View larger version (185K): [in a new window]   Figure 6b. (a) CO2-enhanced abdominal aortogram demonstrates poor opacification (arrow) of the proximal portion of the left renal artery. However, the incomplete filling of the vessels is suggestive of a high-grade stenosis. (b) CO2-enhanced left renal arteriogram obtained after balloon angioplasty of the proximal left renal artery shows that marked residual narrowing (arrow) remains. It is difficult to determine whether the narrowing represents residual plaque, dissection, or thrombus. (c) Gadodiamide-enhanced angiogram better defines the residual stenosis and filling defect along the inferior surface, which are consistent with residual plaque and an intimal flap (arrow). (d) Gadodiamide-enhanced left renal arteriogram obtained after percutaneous stent placement demonstrates a well-positioned stent and patent left renal artery (arrow).

View larger version (157K): [in a new window]   Figure 6c. (a) CO2-enhanced abdominal aortogram demonstrates poor opacification (arrow) of the proximal portion of the left renal artery. However, the incomplete filling of the vessels is suggestive of a high-grade stenosis. (b) CO2-enhanced left renal arteriogram obtained after balloon angioplasty of the proximal left renal artery shows that marked residual narrowing (arrow) remains. It is difficult to determine whether the narrowing represents residual plaque, dissection, or thrombus. (c) Gadodiamide-enhanced angiogram better defines the residual stenosis and filling defect along the inferior surface, which are consistent with residual plaque and an intimal flap (arrow). (d) Gadodiamide-enhanced left renal arteriogram obtained after percutaneous stent placement demonstrates a well-positioned stent and patent left renal artery (arrow).

View larger version (183K): [in a new window]   Figure 6d. (a) CO2-enhanced abdominal aortogram demonstrates poor opacification (arrow) of the proximal portion of the left renal artery. However, the incomplete filling of the vessels is suggestive of a high-grade stenosis. (b) CO2-enhanced left renal arteriogram obtained after balloon angioplasty of the proximal left renal artery shows that marked residual narrowing (arrow) remains. It is difficult to determine whether the narrowing represents residual plaque, dissection, or thrombus. (c) Gadodiamide-enhanced angiogram better defines the residual stenosis and filling defect along the inferior surface, which are consistent with residual plaque and an intimal flap (arrow). (d) Gadodiamide-enhanced left renal arteriogram obtained after percutaneous stent placement demonstrates a well-positioned stent and patent left renal artery (arrow).