Potential of carbon dioxide angiography in the treatment of critical renal artery lesions in a patient with chronic kidney disease: a case report

The combination of atherosclerotic coronary and renal system lesions is quite common in clinical practice, while the risk of cardiovascular complications in such patients is tens of times higher than in the general population, which is associated with a sharp acceleration of vascular damage. The use of minimally invasive surgery, in particular endovascular renal artery revascularization, can improve excretory renal function and delay the need for renal replacement therapy. However, the use of nephrotoxic contrast agents in the presence of chronic kidney disease in a patient can become a key limiting factor for the use of endovascular treatment methods. The way out of this situation is the use of non-contrast endovascular surgery under the carbon dioxide angiography and intravascular imaging guidance. The article presents a case of successful balloon angioplasty and stenting of critical stenosis of the right renal artery in a comorbid patient under the carbon dioxide angiography and intravascular ultrasound guidance.

1. Arutyunov AG, Batluk TI, Bashkinov RA, et al. Multifocal atherosclerosis: focus on the prevention of ischemic events. Russian Journal of Cardiology. 2021;26(12):4808. (In Russ.) doi:10.15829/1560-4071-2021-4808.

2. Idrisov IA, Khafizov TN, Khafizov RR, et al. Renal Artery Stenosis, Diagnosis and Management: a Literature Review. Creative surgery and oncology. 2021;11(3):235-43. (In Russ.) doi:10.24060/2076-3093-2021-11-3-235-243.

3. Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery. Eur Heart J. 2018;39(9):763-816. doi:10.1093/eurheartj/ehx095.

4. Wheatley K, Ives N, Gray R, et al. Revascularization versus medical therapy for renal-artery stenosis. N Engl J Med. 2009; 361(20):1953-62. doi:10.1056/NEJMoa0905368.

5. Cooper CJ, Murphy TP, Cutlip DE, et al. Stenting and medical therapy for atherosclerotic renal-artery stenosis. N Engl J Med. 2014;370(1):13-22. doi:10.1056/NEJMoa1310753.

6. Tuttle KR, Dworkin LD, Henrich W, et al. Effects of Stenting for Atherosclerotic Renal Artery Stenosis on eGFR and Predictors of Clinical Events in the CORAL Trial. Clin J Am Soc Nephrol. 2016;11(7):1180-8. doi:10.2215/CJN.10491015.

7. Hicks CW, Clark TWI, Cooper CJ, et al. Atherosclerotic Renovascular Disease: A KDIGO (Kidney Disease: Improving Global Outcomes) Controversies Conference. Am J Kidney Dis. 2022;79(2):289-301. doi:10.1053/j.ajkd.2021.06.025.

8. Reinhard M, Schousboe K, Andersen UB, et al. Renal Artery Stenting in Consecutive High-Risk Patients With Atherosclerotic Renovascular Disease: A Prospective 2-Center Cohort Study. J Am Heart Assoc. 2022;11(7):e024421. doi:10.1161/JAHA.121.024421.

9. Homorodean C, Ober MC, Spinu M, et al. Outcomes after stenting of renal artery stenosis in patients with high-risk clinical features. Egypt Heart J. 2024;76(1):4. doi:10.1186/s43044-024-00435-z.

10. Kazantsev AV, Burkov NN, Lider Ryu, et al. In-hospital results of renal artery stenting in patients with multifocal atherosclerosis. Pirogov Russian Journal of Surgery. 2020;(3):43-7. (In Russ.) doi:10.17116/hirurgia202003143.

11. Li Y, Wang J. Contrast-induced acute kidney injury: a review of definition, pathogenesis, risk factors, prevention and treatment. BMC Nephrol. 2024;25(1):140. doi:10.1186/s12882-024-03570-6.

12. Adachi Y, Endo A, Nakashima R, et al. Renal Artery Stenting Using CO2 Gas Angiography in Combination with Iodinated Contrast Angiography. Intern Med. 2016;55(17):2419-22. doi:10.2169/internalmedicine.55.6846.

13. Semukhina EN, Semukhin MV, Zyryanov IP, et al. Phased stenting of renal arteries using introvascular ultrasound in patient with arterial hypertension. Siberian Medical J. 2013;28(2):69-74. (In Russ.)

14. Lee SR, Ali S, Cardella J, et al. Carbon dioxide angiography during peripheral vascular interventions is associated with decreased cardiac and renal complications in patients with chronic kidney disease. J Vasc Surg. 2023;78(1):201-8. doi:10.1016/j.jvs.2023.03.029.