Endovascular Revascularization under Carbon Dioxide Angiography

Abstract

We have long advocated the usefulness, accuracy and safety of carbon dioxide angiogrphy for patients with iodine allergy and renal dysfunction. In addition to its utility, no specialized apparatus is necessary for carbon dioxide angiography. Carbon dioxide as a contrast material has been adopted by consensus for use in endovascular revascularization. Here we report 4 cases of endovascular revascularization using carbon dioxide angiography. Two of the four patients had an iodine allergy, one had renal dysfunction, and the remaining one was complicated by diabetes mellitus. All patients exhibited intermittent claudication and were treated for iliac arterial stenotic lesions with percutaneous angioplasty and sequential endovascular stenting using carbon dioxide gas as a negative contrast material. All cases demonstrated improvement of the chief complaint. There were no direct or indirect complications of carbon dioxide angiography and endovascular intervention after the procedures. All 4 patients were discharged without event within 1 week after the endovascular intervention. Carbon dioxide is useful not only as an angiographic contrast material but also for endovascular intervention in patients with iodine allergy or renal dysfunction.

Endovascular Therapy Using Diluted Contrast Medium for Critical Limb Ischemia in a Patient with Chronic Kidney Disease

“…16,17) However, this method is associated with severe complications and poor image quality. 18) Carbon dioxide angiography results in poor imaging of BTK lesions because of gas bubbles. Moreover, patients often experience severe pain that may cause them to move their legs during the procedure.…”

Tumescent TAPP: laparoscopic inguinal hernia repair after the preperitoneal tumescent injection of diluted lidocaine and epinephrine saline solution and carbon dioxide gas

“…The safety and efficacy of CO 2 as a satisfactory submucosal injection agent during ESD have been demonstrated. Shikata H et al [22] performed endovascular revascularization under CO 2 gas angiography for patients with iodine allergy and renal dysfunction and found no direct or indirect complications of CO 2 gas angiography after injecting up to 200 ml of CO 2 gas. Consequently, we think that the infusion of CO 2 gas into the preperitoneal space does not cause any clinical problems unless a very large volume of CO 2 gas, probably over 200 ml, is injected directly into blood vessels.…”

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).…”