An abnormally large number of individuals with a history of recent vascular surgery have gone on to develop nephrogenic systemic fibrosis (NSF), leading to a strong association between vascular surgical procedures & NSF.
Nephrogenic Systemic Fibrosis Background
Nephrogenic systemic fibrosis (NSF), also known as nephrogenic fibrosing dermopathy (NFD), is a disease of fibrosis of the skin and internal organs. NSF typically occurs in patients with renal insufficiency who have had imaging studies with gadolinium, a contrast agent used in imaging studies. Gadolinium can be found in tissue samples of nephrogenic systemic fibrosis. Evidence for a link between nephrogenic systemic fibrosis and gadolinium was first described in a case series of 13 patients, all of whom developed nephrogenic systemic fibrosis after being exposed to gadolinium.
NSF & Vascular Surgery
In a 2006 study published in the American Journal of Roentgenology, six patients had a vascular surgery performed within a 17-day period after gadodiamide injection, including liver transplantation (four patients), arteriovenous graft revision (one patient), and thrombectomy of renal transplant and right external iliac vein thrombus (one patient). A left thigh fasciotomy was performed on one patient for suspected necrotizing fasciitis 4 weeks after gadodiamide injection.
NSF & Vascular Surgery Study Conclusion
The study concluded that NSF is a disfiguring and potentially disabling or fatal disorder that appears to be strongly associated with or triggered by injection of gadodiamide for MRI and MR angiography examinations in patients requiring vascular surgical procedures.
A combination of factors, including altered kidney function, inflammatory burden, and exposure to gadolinium-based contrast agents may all play a role in development of NSF. Alternative imaging should be considered in patients with these factors. If use of a gadolinium-based agent is clinically indicated, the referring physician and patient should be informed of the potential risk of developing NSF.