Carbon dioxide (CO 2 ) digital subtraction angiography: 26-year experience at the University of Florida

Abstract

Although the vascular system is presently being imaged by multiple high technology modalities, contrast angiography continues to be the gold standard; however, severe complications rarely occur. During the last 25 years (in over 1400 patients), CO2 has proven to be extremely safe (no allergy or renal failure). However, it is imperative to understand CO2's physical properties and potential dangers. Recently, CO2 is being routinely utilized not only because of safety, but for detection of minute amounts of bleeding, better collateral filling, and for most interventional procedures since unlimited volumes of CO2 can be injected between the catheter and guidewire. Presently, safe, reliable and "user-friendly" delivery systems are now commercially available. CO2 DSA images are now nearly comparable to iodinated contrast, and improvement in DSA images are evolving, including "stacking" software.

Gadolinium contrast media are more nephrotoxic than a low osmolar iodine medium employing doses with equal x-ray attenuation in renal arteriography: An experimental study in pigs1

“…One strategy to decrease this risk has been to exchange I-CM to other CM such as carbon dioxide (4,5) or gadolinium CM (Gd-CM) (6 -11). The assumed lower nephrotoxic effect of Gd-CM is partly based on one study (8) in which intraarterial and intravenous doses of I-CM for x-ray arteriography (XRA) and computed tomography, respectively, proved more nephrotoxic than Gd-CM for magnetic resonance angiography in the same patients.…”

Clear Visualization of Extravasation on Angiography Using Carbon Dioxide in a Case of Hepatocellular Carcinoma Rupture with Unclear Visualization Using Iodine Contrast Agent

“…CO2 is also 20 times more soluble in blood than iodine contrast medium and is excreted promptly via respiratory exhalation. In contrast, the viscosity of CO2 is 400 times less than that of iodine contrast medium (9). Although the ability to depict blood vessels using conventional angiography with CO2 is suboptimal, the development of DSA has improved the capacity to visualize blood vessels.…”

“…CO2 was used as a contrast agent for abdominal angiography by Hawkins in the 1970's (9). One advantage of CO2 is that it can be used safely in patients with contrast media allergies or nephropathy.…”

Injetor intravascular de CO2: estudo in vivo de viabilidade inicial do dispositivo e de qualidade de imagem

“…A alternativa escolhida, amplamente embasada na literatura médica, é a injeção intravascular de gás CO 2 purificado em substituição ao contraste iodado, em volume e pressão controlados e apropriados à obtenção de imagens radiológicas (12)(13)(14)(15)(16)(17)(18)(19)(20)(32)(33)(34)(35)(36)(37)(38) . (39)(40)(41), (42) .…”

“…Nas décadas de 1970 e de 1980, o CO 2 foi usado como agente intraarterial de contraste e, com o advento da ASD, em 1980, a angiografia baseada em CO 2 se transformou em uma ferramenta diagnóstica útil, particularmente para pacientes hipersensíveis a contrastes à base de iodo, ou cuja função renal esteja comprometida (19,43) . Há ainda relatos na literatura descrevendo que, quando injetado para a análise angiográfica no tratamento de aneurismas abdominais, o CO 2 pode ficar encarcerado em uma dilatação do sistema vascular, como um aneurisma, complicação encontrada no uso desses métodos (13,32,50) .…”