Contrast-Induced Nephropathy After Peripheral Vascular Intervention

Contrast-induced acute kidney injury (CI-AKI) following peripheral vascular procedures is a well-known but relatively uncommon complication. The literature regarding acute kidney injury (AKI) associated with peripheral angiography is sparse in comparison to the more robust coronary literature, however it suggests distinct differences between these procedures. The reported frequency of CI-AKI in peripheral procedures is highly variable, but the most reliable source supports an incidence of approximately 3%. Risk factors for CI-AKI include pre-existing renal disease, increased age, diabetes, obesity, critical limb-threatening ischemia, and emergency case status. Prevention of CI-AKI is based on two principles: ensuring appropriate hydration and reducing the volume of iodinated contrast. Though contraindicated in coronary and cerebral angiography, carbon dioxide gas may be used safely in the peripheral circulation as an alternative to iodinated contrast. It is non-nephrotoxic, inexpensive, and universally available.