Recent literature shows how residual renal function (RKF), defined as the urinary clearance of
urea and
creatinine, is associated with a lower mortality risk in HD patients. The use of non-nephrotoxic
contrast media during radiological procedure, may be useful for preservation of RKF in patients with
chronic kidney disease not yet in haemodialysis. We describe the case of a 51-year-old male suffering from
chronic kidney disease from 2018, due to a right
nephrectomy for an
adenocarcinoma, who was considered for an endovascular
arteriovenous fistula (endoAVF) creation (WavelinQ endoAVF System, Becton Dickinson, Franklin Lakes, New Jersey, US), using
Carbon Dioxide as
contrast media instead of conventional iodinated ones, with optimal results. CO2 DSA permits to well recognize the patency of target vein, its connection to the perforator vein and finally the endoAVF creation without requiring supplemental
iodate contrast medium. We propose, CO2 automated digital subtraction angiography (DSA) as a safer technique that could be substitutive of the standard iodinated ones, in the creation of endo AVF.