Contrast nephropathy in lower limb angiography.

AIM: This study examines the occurrence of contrast nephropathy in a series of 302 consecutive lower limb angiogram and angioplasty procedures. METHODS: Serum creatinine measurements, 1 and 3 days after the procedures, were used to identify cases of contrast nephropathy, defined as a 25% increase above initial creatinine. These cases were reviewed retrospectively. A total of 267 patients had 224 diagnostic, and 78 interventional lower limb angiographic procedures. Of these, 46% had pre-existing renal impairment (creatinine >118 micro mol/l), of whom 11% were on dialysis - dialysis patients were excluded from analysis of changes in creatinine. Repeat creatinine measurements were taken after 191 procedures. RESULTS: Contrast nephropathy occurred after 15 procedures: of whom 9 died, and 6 recovered. Of these patients, 11 were taking potentially nephrotoxic drugs and 9 had renal impairment. Precautions to avoid contrast nephropathy were taken in only 2 cases. Of the 9 deaths, 6 were associated with severe underlying disease processes, but 3 occurred directly as a result of contrast nephropathy. Contrast nephropathy has an incidence of 8% in this series: the incidence in acute limb-threatening ischaemia is double that for other cases. Death from renal failure is relatively rare, with an incidence of 1%. In uncomplicated angiography or angioplasty, where admission is not prolonged by a need for further treatment, the condition has no mortality. CONCLUSIONS: Accepted precautionary measures should be observed, and alternatives to conventional angiography should be considered - particularly where there is pre-existing renal impairment and other co-morbidity.

Pulmonary Embolism following Endovenous Laser Ablation (EVLA) of the Great Saphenous Vein.

A 70yr old lady presented to accident and emergency with sudden onset pleuritic chest pain. A pulmonary embolus (PE) was diagnosed by CTPA. Ten days earlier she had bilateral EVLA for recurrent great saphenous vein disease. Confounding risk factors for pulmonary embolism included bilateral ligation and stripping of the great saphenous vein a year earlier, malignancy, EVLA and phlebitic tributary varices. EVLA has been shown to be an effective treatment for superficial venous insufficiency with low morbidity and high patient satisfaction. The investigation of confounding risk factors and possible causes should not compromise the initial treatment of PE.