CO2 Digital Subtraction Angiography: Potential Complications and Their Prevention

Carbon dioxide as a contrast agent to guide vascular interventional procedures.

“…However,sev eral complications from CO2 use for angiographyhavebeendescribed.In supinepa tients, the gas may be trappedanteriorly in an abdominal aortic aneurysm.This can result in the nondependent inferior mesentericarteryfill ing with CO2. which can produce stasis and is chemia [17]. Seizures,loss of consciousness, brief respiratoryarrest,or somecombinationof thesecomplicationshavebeendescribedin four patientswhen CO2 refluxedinto the cerebralar tenes.Three of thesepatientspresumablyhad reflux ofCO2 into a vertebralarteryfrom an up per extremity dialysis graft during outflow oc clusionto visualizethe arterialanastomosis [17,22]; therefore, we do not perform arterial CO2 injections above the diaphragm.A recent case report attributeslivedo reticularis,rhabdomyol ysis, massiveintestinal infarction, and deathto CO2arteriography in onepatient withoutpatho logic confirmation of atheroemboli [23].…”

“…No risk of al lergy or renal toxicity from CO2 is known [16], and it is inexpensive [17]. Large quantities may be injectedin bolusesofup to 60 ml each [16].…”

“…Complicationsresultingfrom intravascular CO2 injectionare rare.They oftenrelateto air contaminationof the CO2 or inadvertentdeliv ery of a largevolume of gas [17]. However,sev eral complications from CO2 use for angiographyhavebeendescribed.In supinepa tients, the gas may be trappedanteriorly in an abdominal aortic aneurysm.This can result in the nondependent inferior mesentericarteryfill ing with CO2.…”

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

“…For example, Cardi et al reported side effects in seven of 1,200 cases of CO2 angiogra-phy (19). In order to prevent adverse effects, the total amount of CO2 on angiography should be limited to less than 200 mL, with an upper limit for the rate of application of 25 mL/s (20).…”

The use of carbon dioxide in magnetic resonance angiography: A new type of black blood imaging

“…Therefore MRA roadmaps can probably be reproduced many times without damage to the patient (4). Although some animal experiments did not prove neurotoxicity of CO 2 (5,6), up to now conventional CO 2 angiography in humans above the diaphragm has not been recommended (4,7). To ensure complete passage of the CO 2 bolus to the small distal arteries and subsequent dispersion, in conventional CO 2 angiography the patient is often put in a Trendelenburg position (lower body positioned slightly upward).…”