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1 Supplementary Online Content Smith D, Chudgar A, Daly B, Cooper M. Evaluation of potential renal transplant recipients with computed tomography angiography. Arch Intern Med. doi: /archsurg efigure 1. Review process for determining whether CTA played a role in preclusion of transplantation. efigure 2. Review process for determining whethger CTA played a role in changing graft anastomosis site. efigure 3. Review process for determining whether CTA played a role in subsequent therapeutic procedures and specialist management. Note that all diagnostic imaging and procedures, regardless of whether they altered management, were included as in the cost analysis. etable 1. Cohort demographics, history, and physical examination findings (N=179) etable 2. Aggregate CTA findings etable 3. Nonstandard anastomosis due to CTA findings (n=22) etable 4. Therapeutic procedures due to CTA findings (n=20) This supplementary material has been provided by the authors to give readers additional information about their work.
2 efigure 1. Review process for determining whether CTA played a role in preclusion of transplantation.
3 efigure 2. Review process for determining whether CTA played a role in changing graft anastomosis site.
4 efigure 3. Review process for determining whether CTA played a role in subsequent therapeutic procedures and specialist management. Note that all diagnostic imaging and procedures, regardless of whether they altered management, were included as in the cost analysis.
5 etable 1. Cohort Demographics, History, and Physical Examination Findings (N=179) 1 DEMOGRAPHICS MEDICAL HISTORY 4 PHYSICAL AGE 1 CAD 35 HEIGHT 12 <30 17 CHF 5 < 168 cm (66) Cardiomyopathy cm (72) Valvular Disease 8 > 183 cm 21 >70 13 PVD 14 PE 6 WEIGHT GENDER DVT 9 < 69 kg (100) 49 Male 106 Aortic Disease kg (150) 71 Female 73 Prior Renal Transplant 31 > 91 kg 59 Other Prior Transplant 4 RACE Cancer (Any Type) 23 BMI White 107 DM1 20 < Black 62 DM Other 2 10 Thyroid disease Autoimmune Disorder 6 13 > ESRD HISTORY Chronic Infection 7 11 BPH 7 ABDOMEN ESRD CAUSE Torso Scars HTN 52 OTHER HISTORY Palpable mass 8 DM 30 HTN+DM 33 SOCIAL EXTREMETIES PCKD 16 Tobacco 8 82 Edema 20 IGAN 5 Alcohol 9 13 Decreased pulses 19 Congenital IVDA 10 6 Abn. 4 Other/Unknown 25 FAMILY 11 DIALYSIS - HD Breast Cancer 18 None 55 Adnexal Cancer 3 < 2 years 78 Prostate Cancer years 35 Colon Cancer 9 > 4 years 11 DIALYSIS - PD None 153 < 2 years years 5 > 4 years 3 DIALYSIS - TOTAL None 43 ESRD: End Stage Renal Disease. HTN: Hypertension. DM: Diabetes Mellitus. PCKD: Polycystic Kidney Disease. FSGS: Focal Segmental Glomerulosclerosis. IGAN: IgA Nephropathy. Abn: Abnormalities. PD: Peritoneal Dialysis. HD: Hemodialysis. egfr: Estimated Glomerular Filtration Rate. CAD: Coronary Artery Disease. CHF: Congestive Heart Failure. PVD: Peripheral vascular disease. PE: Pulmonary Embolism. DVT: Deep Vein Thrombosis. BPH: Benign Prostatic Hypertrophy. (1) At time of CTA. (2) Other includes Hispanic, Asian, and American Indian (3) Calculated from SCr closest to CTA time using Cockcroft-Gault formula.
6 < 2 years years 41 > 4 years 13 < (4) Medical history was not analyzed for ESRD-caused pathologies (ie HTN, anemia, hyperparathyroidism) (5) Includes hyper- or hypo-thyroidism (6) Psoriasis not included. (7) Includes Hepatitis B, Hepatitis C, HIV, tuberculosis (8) Defined as >2 pack year history of smoking cigarettes or cigars. (9) Defined as a history of one of the following: binge drinking, alcoholism, alcohol dependence, heavy alcohol use. (10) Any IV drug abuse is considered positive. (11) 1 o family only. (12) Values in parentheses are traditional standards of measurement (inches for height, pounds for weight) (13) Surgical scarring on chest and/or abdomen.
7 etable 2. Aggregate CTA Findings VASCULATURE MASSES TRANSPLANT Aortoiliac 27 Renal 10 Kidney Atherosclerosis Mild Adrenal Mass or 3 6 Pancreas Hyperplasia Moderate 2 42 Adnexal 6 8 Severe 3 23 Prostatic 6 11 OTHER EIA Atherosclerosis 4 36 Heart 15 Other mass 11 Abnormality EIA Stenosis 8 PE 1 Venous Disease 5 6 Other Vascular Abnormality 14 EIA: External Iliac Artery. PE: Pulmonary Embolism (1) Mild includes the following descriptions: no significant, minimal, mild, free of, scattered (2) Moderate includes the following description: moderate (3) Severe includes the following descriptions: severe, extensive, heavy, widespread (4) All other categories are either categorized as either present or absent (5) Venous disease includes either of the following: abdominal venous obstruction with/without collateralization, permanent IVC filter in place (6) Adrenal and Prostate masses include either mass or generalized enlargement. (7) Lung bases are usually visible on standard abdomen/pelvis CT scans.
8 etable 3. Nonstandard Anastomosis Due to CTA Findings (n=22) Anastamosis Sites # Pts CTA Finding(s) LEI Artery and Vein 10 Calcified Atherosclerotic Disease Involving Right External Iliac Artery with or without stenosis. 3 Extensive Post-surgical Scarring 1 Unilateral enlarged polycystic kidney 1 Multiple prior transplants in place with post-surgical scarring on right AF graft and REI vein 1 Bilateral external iliac artery occlusion requiring aortobifemoral bypass. Transplant was anastamosed to grafts. RCI artery and IVC 3 Multiple prior transplants in place with scattered atherosclerosis throughout abdomen and pelvis. Space and calcification-free near proximal RCI Artery. RCI artery and vein 3 Severe bilateral external iliac artery calcified atherosclerotic disease with or without stenosis. LEI: Left External Iliac. RCC: Renal Cell Carcinoma. AF: Aortofemoral. REI: Right External Iliac. RCI: Right Common Iliac. IVC: Inferior Vena Cava.
9 etable 4. Therapeutic Procedures Due to CTA Findings (n=20) Therapeutic Procedure(s) CTA Finding(s) # Unilateral laparoscopic nephrectomy Suspicious Renal Mass 6 Bilateral open nephrectomy: complex 2 for spatial issues. 1 for infection prophylaxis. Neither patient was symptomatic by history. 3 Aortobifemoral bypass with artificial grafting Bilateral external iliac artery occlusion. 1 Cystotomy with stone removal Large Bladder Stone. 1 Simultaneous umbillical and inguinal hernia repair. Inguinal hernia containing bladder. Umbillical hernia containing small bowel. 1 RLE arteriogram w/ embolization Right femoral artery pseudoaneurysm. 1 AAA repair with pre-operative aortogram Infrarenal AAA without visceral branch involvement. 2 Recurrent ventral hernia repair and mesh Outpatient specialist treatment and follow-up of disease AAA: Abdominal Aortic Aneurysm. Large ventral hernia containing colon, adipose tissue, and small bowel. Physical exam unremarkable. 1x Markedly enlarged prostate. 1x Large renal cyst. 1x Severe aortoiliac disease. 1x Complex adnexal Mass. 1 4
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