A 67-Year-Old Woman Is Evaluated for Intermittent Claudication Prior to Angiography

A 67-year-old woman is evaluated for intermittent claudication prior to angiography.  At a recent evaluation, her ankle-brachial index was 0.65 on the right and 0.75 on the left.  The patient has a history of long-term cigarette smoking, hypertension, type 2 diabetes mellitus, hyperlipidemia, and severe degenerative arthritis of the knees.  Current medications include simvastatin, ibuprofen, glipizide, and amlodipine.
Blood pressure is 130/86 mm Hg and pulse is 72/min.  Cardiac examination reveals a grade 2/6 systolic ejection murmur at the base.  The lungs are clear and there is no jugular venous distension.  Tibial pulses are 1+ and the patient has trace pedal edema of the ankles bilaterally.
Serum creatinine is 2 mg/dL and urinalysis shows 2+ proteinuria.
In addition to using the smallest dose of a third-generation contrast agent and prehydrating with normal saline, which of the following is the most appropriate precaution for this patient's angiography?

A) Discontinuation of ibuprofen
B) Furosemide during and following the procedure
C) Intravenous dopamine during the procedure
D) Mannitol prior to and during the procedure
E) Prophylactic hemofiltration

Correct Answer:

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