History: A 64-year-old obese man with radiocontrast-induced nephropathy, which required temporary hemodialysis, was referred for treatment of an infrarenal abdominal aortic aneurysm detected incidentally. Comorbidities were obesity (BMI 44.1), non-insulin dependent diabetes mellitus, arterial hypertension, COPD, and renal failure with decompensated retention.
Investigations: MRI demonstrated a 6.1 cm diameter infrarenal partially thrombosed aortic aneurysm which extended to the aortic bifurcation. Its morphology was favourable for endovascular treatment.
Treatment and course: An aortobiiliac stent graft was inserted after bilateral arterial femoral cut-down. As a contrast agent we administered 0.5 molar gadoteridol solution only. The total volume used was 90 ml (0.375 mmol/kg body weight). The aneurysm was completely excluded. No further signs of renal deterioration occurred.
Conclusion: Non-nephrotoxic gadolinium-containing contrast media allow minimal invasive exclusion of infrarenal aortic aneurysms with use of stent grafts in patients in whom conventional iodinated x-ray contrast agents are contraindicated.