Hungarian Radiology

[Initial experiences with upper limb MR-angiography]


DECEMBER 21, 2009

Hungarian Radiology - 2009;83(04)

[INTRODUCTION - Cimino fistula is created for chronic hemodialysis. As a common complication steal syndrome may occur. Till recently, color Doppler and catheter angiography were the gold-standard diagnostic tools. We have performed MR-angiography of the upper limb to replace the more invasive conventional angiography in patients with poor general condition. PATIENT AND METHODS - A case of a 64 years old female patient with known type II diabetes is presented. Due to azotemia, the patient has received hemodialysis for 24 months, via a left upper limb fistula. This fistula occluded, and the Cimino-fistula was later created on the right arm. This new fistula demonstrated steal syndrome, and required formal ligation. In the meantime a necrotising drygangrene of the 4th and 5th digits was recognised. This required an emergent conventional angiography, but due to the unavailability of accessible artery, MR-angiography was performed. 1.0 mmol/ml concentration gadobutrol (Gadovist 1.0, BayerSchering, Berlin) was used to reduce the chances of nephrogenic systemic fibrosis in this patient with poor renal function. CONCLUSION - Correctly performed MR-angiography to examine the possibility of steal syndrome in patients with a Cimino fistula can be a feasible alternative. The advantages of the procedure include its minimal invasiveness, no ionizing radiation and the risk of iodine-based contrast material nephrotoxicity. Also, as compared to digital substraction angiography, with MR-angiography we obtain a high-resolution, isotrope voxel-sized 3D acquisition which can be better read in many different planes. As a drawback, currently on-location intervention cannot be performed, if needed. Also, the waiting periods may be long.]



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