A Pharmacoangiographic Method for Improving Nephrophleboqraphy

DENAL VEINS are normally observed during the venous phase of selective renal arteriography, but the contrast density is low because of dilution and excretion of the medium in the kidney. Cortical veins are never seen because they are concealed by the dense, contrastfilled parenchyma. Density in the venous phase has been improved in animals by using radiopaque agents which are not filtered by the kidney, such as Thorotrast (3) and emulsified oil (12), but because of their toxicity these agents cannot be employed in man. The most common method of demonstrating renal vein morphology is by catheterization of that vein, followed by retrograde injection of contrast medium against renal blood flow (5, 10). This flow quickly rinses out the medium and prevents adequate filling of the peripheral renal veins. Good filling of the peripheral renal veins has been obtained by injecting contrast material at high pressures between the balloons of a double-balloon catheter, which have been inflated on either side of the renal veins in the inferior vena cava (11). The double-balloon technic has been combined with either increased intrabronchial pressure or a balloon catheter inflated in the aorta above the renal arteries, both of which decrease renal blood flow (6). These technics are, however, rather complicated and have so far been attempted only in animals and a few patients. The Valsalva maneuver has also been employed to decrease cardiac output and increase the pressure in the inferior vena cava during injection of contrast medium into a renal vein. Although this is an easy procedure to perform, there is little improvement in the quality of the examination. In addition, renal veins have been demonstrated by the percutaneous injection of contrast medium into the renal parenchyma (7) and by injection into the surgically exposed left spermatic vein in the inguinal canal (8). Following angiographic demonstration of the vasoconstrictive effect of epinephrine on the renal arteries of dogs (1) and in man (2), it seemed possible to achieve contrast filling of the entire renal venous system by performing selective phlebography after injection of a vasoconstrictive drug into the renal artery. We have performed 20 nephrophlebographies with this method. The purpose of the present report is to present our results and to consider some of the technical factors affecting the quality of the examination. Materials and Methods Twenty nephrophlebographies were performed in 19 patients following diminution of renal blood flow with either epinephrine (Adrenalin, ACO, Sweden) or angiotensin (Hypertensin N, Ciba, Switzerland). Epinephrine was used in 14 examinations and angiotensin in 6. In 14 of the 20, a control nephrophlebography was first performed without the drug, but with all other factors the same. A thin-walled KIFA red catheter (I.D./ O.D. = 1.5/2.2 mm) was used for the renal vein in 16 examinations and a KIFA gray catheter (I.D./O.D. = 1.8/ 2.8 mm) in the remainder.