Chronic kidney disease (CKD) carries a well-established risk for adverse events during revascularization of the lower extremities and is an important determinant of patient prognosis in critical limb ischemia (CLI). Although endovascular therapy offers a minimally invasive approach in this high-risk group of patients, the administration of nephrotoxic contrast agent can lead to further deterioration of the renal function. Thus, the development of strategies that can minimize the risk for renal injury during endovascular procedures remains crucial.
We report a case of a patient who presented at our institution with CLI (Rutherford class 5) and CKD stage IV. Carbon-dioxide angiography revealed a severely calcified lesion of the popliteal artery with a single vessel run-off through the peroneal artery. Endovascular lithoplasty followed by drug-coated balloon (DCB) angioplasty was selected for the treatment of the severely calcified popliteal artery.
Key words: chronic kidney disease, critical limb ischemia, endovascular lithoplasty, CO2-angiography, drug-coated balloon