The International Journal of Cardiovascular Imaging - CALL FOR PAPERS: Noninvasive and Invasive Vascular Imaging in the End-Stage Renal Disease Population

There is a continuous increase in the end-stage renal disease (ESRD) population and the management of this chronic disease is complex. Renal replacement therapy options include hemodialysis, peritoneal dialysis, and for selected patients, renal transplant. Invasive and noninvasive vascular imaging is an important pillar in the management and guidance of therapeutic options for these patients. The majority of patients with ESRD receive renal replacement therapy via hemodialysis. For hemodialysis, appropriate vascular access is required in the form of an arteriovenous fistula, arteriovenous graft, or a tunneled dialysis catheter. In order to surgically or endovascularly create an arteriovenous fistula or arteriovenous graft, proper preoperative procedure planning is warranted, i.e., venous and arterial vascular mapping. In preoperative mapping, different technologies or modalities can be used, such as ultrasound, including more recent ultrasound developments such as contrast enhanced ultrasound and ultrasound elastography, CT angiography, and MR angiography, as well as invasive iodine-based and CO2-based angiography.

Once the vascular access has been created, maintenance is warranted using primarily surveillance ultrasound to detect associated complications such as stenotic disease, thrombotic disease, or pseudoaneurysm formation. These complications are subsequently treated by performing an endovascular first treatment approach. The correlation between preprocedural noninvasive vascular imaging approaches and the subsequent findings on the invasive fistulogram plays a vital role in the daily clinical practice and patient management.

Select ESRD patients are candidates for renal transplant and dedicated vascular imaging in the form of ultrasound and cross-sectional imaging prior to the procedure is of utmost importance to ensure candidacy, including adequate vascular arterial supply and venous outflow. Imaging is also utilized for general preprocedural planning purposes, including location selection for the renal transplant (right versus left iliac fossa).

Beyond the vascular access imaging for ESRD, these patients are at an increased risk for cardiovascular disease. In fact, the number one mortality cause for ESRD patients is cardiovascular events. For risk stratification purposes, imaging of other atherosclerotic diseases is performed using different cross-sectional techniques. Coronary arterial imaging also plays a pivotal role in this patient population.

Finally, in ESRD patients, specific aspects must be taken into account based on the utilized modality, particularly when selecting the appropriate contrast agent. Intravenous iodine-based CTA contrast agents are nephrotoxic, which may only be relevant for ESRD patients with residual urinary output. Specific protocols, such as preprocedural IV hydration, exist. The nephrogenic systemic fibrosis risk with MR contrast agents is almost negligible when using state-of-the-art group II MR contrast agents. There is an ongoing debate around dialysis timing when administering MR and CT contrast agents. The microbubbles used for contrast enhanced ultrasound are not nephrotoxic, and these agents are excreted via the respiratory tract.

This special issue will encompass the broad aspects of noninvasive and invasive vascular imaging in the end-stage renal disease population, including a variety of invited high-quality, multidisciplinary articles. These articles will be written by national and international experts from different specialties, including nephrology, vascular surgery, and interventional radiology, as these specialties are primarily involved in the care of this complex patient population. The deadline for submission of all articles for this special issue is 7/31/2024.

In case of questions, please do not hesitate to contact us.

Sasan Partovi, MD, Interventional Radiology, Cleveland Clinic Main Campus, Cleveland, Ohio, United States

Levester Kirksey, MD, Vascular Surgery, Cleveland Clinic Main Campus, Cleveland, Ohio, United States

Cassandra Kovach, MD, Kidney Medicine, Cleveland Clinic Main Campus, Cleveland, Ohio, United States