Intravascular Ultrasound-Guided Angioplasty of Hemodialysis Loop Graft in a Patient with Contrast Allergy

Purpose A surveillance duplex scan detected a stenosis within a left groin hemodialysis loop graft in a 57-year-old woman who was allergic to both iohexol and gadolinium contrast agents. This precluded the use of standard angioplasty treatment techniques. Intravascular ultrasound (IVUS) uses a catheter mounted with a miniaturized ultrasound probe to produce detailed cross-sectional vessel images. Clinically, it has been used in the assessment of coronary artery disease but has also supplemented standard angiography techniques in the assessment of peripheral vascular and hemodialysis access lesions. Methods IVUS was utilized as the solitary imaging modality to identify the graft stenosis and guide the placement of a 6 mm diameter angioplasty balloon. Two areas of stenosis were successfully dilated and subsequent IVUS re-examination showed abolition of the stenosis. Results Twelve-month follow-up surveillance scan showed that the graft remained functional with good flow rates. Conclusions In the setting of contrast allergy, IVUS may provide a valid and safe tool in the localization and treatment of peripheral vessel stenosis, including arteriovenous fistula angioplasty. To our knowledge this is the first reported use of IVUS for hemodialysis graft salvage adopting a completely ‘contrast-free’ technique. More studies are required to establish the true role of IVUS in the management of hemodialysis access angioplasty, but this successful case contributes valuable information to the literature on its clinical application.