Carbon dioxide CT angiography during endovascular treatment of bilateral common iliac disease with angio‐CT utilisation

Abstract

This paper presents the application of carbon dioxide for CT imaging during an endovascular procedure to help characterise unexpected bilateral common iliac artery stenosis utilising an angio-CT system, confirming its application in interventional radiology while maintaining sterility. A 78 year old male was referred to the Radiology Interventional Suite with left lower limb rest pain. On imaging via digital subtraction angiography and CT utilising both iodinated contrast and carbon-dioxide (CO ), endovascular treatment of bilateral CIA stenosis was performed with good clinical result. The case presented demonstrates the advanced imaging techniques possible in suites that have ready access to angiography and conventional CT. CO CT angiography is optimally performed on combined Angio-CT systems where CT and angiography system are integrated into a single room.

CO2-based C-arm computed tomography (CACT) of the pelvic arteries: feasibility and diagnostic performance in comparison to CO2-angiography in patients with peripheral arterial disease

“…However, aorta and pelvic artery assessment is often challenging due to obesity and bowel gas. In some cases, even highgrade stenosis of the (common) iliac arteries could not be adequately demonstrated sonographically, even when compared to different other techniques such as CTA (23). Although radiation-free and without contrast agent, sonographic guidance is mainly used for superficial femoral artery interventions since the challenges for pelvic arteries mentioned earlier also apply (24).…”

“…Due to its nontoxicity, CO 2 can be used in large amounts for the intraprocedural angiographic guidance of an intervention (14,20). A recognized potential issue for projection-based imaging with the threat of IQ deterioration is motion artifacts caused by bowel peristalsis (6,14,23). CACT, a three-dimensional technique frequently utilized for image guidance, showed advantages concerning image quality due to elimination of vessel superimposition and improvements of soft-tissue resolution, overcoming known limiting factors such as bowel gas in DSA.…”

“…While all relevant stenoses could be recognized with CACT, only 50% of them could be detected in DSA images. The considerably lower values in DSA might in part be explained by the aforementioned factors such as presence of bowel gas, peristaltic and ventilation movement, sub-optimally displaying target lesions and, thus decreasing diagnostic value (6,18,23). Furthermore, various studies have shown advantages of CACT over projection-based two-dimensional DSA on the basis of elimination of vessel-superimposition and improved soft tissue resolution (38)(39)(40).…”

The evolution of interventional radiology literature in Australia and New Zealand

“…In addition, interventional topics have been increasing over the last 5 years. We have seen topics of safe IR‐led sedation, 4,5 diagnostic and technical experiences through all body systems 6‐21 and have been shown that IR offers low‐cost alternatives to traditional surgical procedures 22‐24 …”