Abstract
Background: Ferumoxytol is an Ultrasmall Superparamagnetic Iron Oxide (USPIO) which has demonstrated promise as a novel contrast agent with an excellent safety profile in patients with CKD. Our aim was to evaluate the safety and utility of this agent for diagnosis and operative planning in the setting of PAD and CKD. A comparison with digital subtraction angiography is also provided. Methods: Between April, 2013 and September, 2014 seven patients with renal insufficiency (CKD ≥ Stage 3) and symptomatic PAD underwent Fe-MRA. This was followed by DSA limited to the vascular bed with significant stenosis as detected by Fe-MRA. Renal function was assessed before and after each procedure. Images were qualitatively scored at the iliac, femoral, popliteal and tibial levels by two interventional radiologists. Degree of stenosis was also scored for comparison. Results: Seven male patients were studied with a mean age of 75 years (64-92). 5 therapeutic procedures (4 endovascular and 1 open) were performed. There were no statistically significant differences in creatinine or GFR after Fe-MRA or DSA. Iodinated contrast load (mg I) for DSA was reduced in comparison with age and disease matched controls (8240 ± 5206 vs. 29320 ± 15605, p=0.001). No statistically significant differences were found for degree of stenosis or mean image quality score below the iliac level. There were no adverse events in response to Ferumoxytol administration. Conclusion: Fe-MRA provides image quality and estimation of degree of stenosis comparable to DSA. Fe-MRA may serve as an alternative to CTA or gadoliniumbased MRA for patients with end-stage renal disease.
Highlights
The association between Peripheral Arterial Disease (PAD) and Chronic Kidney Disease (CKD) is well established with an estimated 7.4-24% of patients with stage ≥ 3 CKD carrying a clinical diagnosis of PAD [1]
Gadolinium-based agents are not used without risk in the setting of advanced CKD due to their association with Nephrogenic Systemic Fibrosis (NSF) [5]
Our pilot evaluation of ferumoxytol as a contrast agent for preoperative planning in the setting of peripheral arterial occlusive disease demonstrates that ferumoxytol-enhanced MRA (Fe-MRA) provides image quality that is comparable to the gold standard Digital Subtraction Angiography (DSA)
Summary
The association between Peripheral Arterial Disease (PAD) and Chronic Kidney Disease (CKD) is well established with an estimated 7.4-24% of patients with stage ≥ 3 CKD carrying a clinical diagnosis of PAD [1]. Impaired renal function is prevalent among patients with PAD in the range of 27-36% [2,3]. This correlation poses a problem for vascular interventionists who rely heavily on contrast-based imaging for operative planning. Magnetic resonance angiography using gadolinium- based agents provide high quality vascular imaging with less nephrotoxicity and a decreased adverse reaction profile. Gadolinium-based agents are not used without risk in the setting of advanced CKD due to their association with Nephrogenic Systemic Fibrosis (NSF) [5]. Our aim was to evaluate the safety and utility of this agent for diagnosis and operative planning in the setting of PAD and CKD.
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