Endovascular Coiling in a Patient with Chronic Kidney Disease—A Challenge for Anesthesiologist

Abstract

A 41-year-old male patient, a known case of autosomal dominant polycystic kidney disease (ADPCKD), presented to our institute with right middle cerebral artery aneurysm for which balloon-assisted endovascular coiling was planned. The major comorbidities were hypertension and end-stage renal disease (ESRD) on hemodialysis, twice weekly. Endovascular coiling was performed under general anesthesia, and special precautions were taken with regard to monitoring, fluid management, use of heparin, and contrast agent. The intraoperative and postoperative course was uneventful, and the patient was discharged after 7 days. In this report, various perioperative challenges of patients with chronic renal failure during coiling are discussed along with the measures to prevent the occurrence of contrast-induced nephropathy.

Keywords

• autosomal dominant polycystic kidney disease
• contrast induced nephropathy
• end-stage renal disease
• endovascular coiling
• iso-osmolar contrast medium