Safety of Carbon Dioxide Digital Subtraction Angiography

Abstract

Reports of fatality following carbon dioxide digital subtraction angiography (CO 2-DSA) have raised concerns regarding its safety. This study reviews the safety of CO 2-DSA.

Novel use of carbon dioxide arteriography in renal artery pseudoaneurysm in patients with poor renal function

“…A phenomenon termed vapour lock, or trapping of gas in the non-dependent vasculature, has been reported in four case reports in the literature 10. It can be broken by changing the patient's position or by aspirating any trapped CO 2 12 and prevented by using a closed CO 2 injection system to avoid contamination with room air 10. Overall, CO 2 is a safe, non-nephrotoxic alternative to traditional iodinated contrast angiography, with potential applications with RAP and CKD.…”

“…Intra-arterial use of CO 2 was first described by Hawkins9 and has been effectively used in a variety of diagnostic and interventional procedures 10. Unlike contrast, which mixes with blood, CO 2 displaces blood, effectively reducing the attenuation of the blood vessel 11.…”

“…Image quality using CO 2 is typically reduced relative to iodinated contrast, but is sufficient for most procedures 11. In certain situations, small supplemental doses of contrast can assist in delineating the vasculature 10. One study has reported use of CO 2 angiography in 700 patients with no significant decline in renal function in patients, including the subgroup with serum creatinine level ≥2 mg/dL 10…”

“…Another risk includes cerebral infarction, which can be prevented by avoiding use of CO 2 above the diaphragm and in patients with a right-to-left intracardiac shunt 11. A phenomenon termed vapour lock, or trapping of gas in the non-dependent vasculature, has been reported in four case reports in the literature 10. It can be broken by changing the patient's position or by aspirating any trapped CO 2 12 and prevented by using a closed CO 2 injection system to avoid contamination with room air 10.…”

CO2 Angiography: Application and Caution

“…Since CO 2 is non-allergenic and nonnephrotoxic, not inducing nephrogenic systemic fibrosis, 21 it can serve as a safe and effective alternative intravascular contrast agent in patients with renal impairment or an iodinated contrast allergy. [22][23][24][25][26][27] …”