Blood access intervention therapy using Gadoteridol for a patient with iodine allergy

Abstract

In recent years, the usefulness of interventional treatment for stenosis and/or obstruction of blood access has been reported, and such intervention is expected to enter the mainstream of the medical treatment. Generally, a non-ionic iodine contrast agent is used for the imaging study and treatment in these cases. However, an iodine contrast agent, regardless of whether it is ionic, causes critical complications in patients with iodine allergy. In these cases, there has been no other alternative but to perform Digital Subtraction Angiography (DSA) using the carbon dioxide gas, Magnetic Resonance Imaging (MRI), or ultrasound sonography of the body surface or intraluminal region. However, these modalities do not easily and safely provide pictures as good as those obtained with DSA using iodinated contrast agent.
We performed blood access intervention therapy (BAIVT) a total of 7 times in 3 patients with iodine contraindications by DSA using the gadolinium contrast agent generally used in enhanced MRI. It was reported in the basic examination that a 5-fold diluted solution of the iodine contrast agent provides almost the same contrast as an undiluted solution of gadolinium contrast agent. In our procedure, an undiluted solution of the gadolinium contrast agent was used, and we obtained good images in all cases without any remarkable side effects. The total quantity of the gadolinium contrast agent tended to be larger than that for MRI.
Because the effect of gadolinium contrast agent is obviously inferior to that of iodine contrast, DSA equipment is used in principle. However, it was considered effective in cases that are unable to undergo BAIVT because of iodine allergy.