Venography with carbon dioxide as a contrast agent.
OBJECTIVE
The purpose of this study was to evaluate the feasibility, safety, and potential role of carbon dioxide (CO2) as a contrast agent for venography.


METHODS
Consecutive patients with contraindications to iodinated contrast agents or with unsatisfactory iodinated contrast studies underwent CO2 digital subtraction venography. The images were rated by three experienced angiographers. Image quality and complications were assessed.


RESULTS
Over a 14-month period, 66 vein segments were studied in 21 patients. There was good correlation between experienced angiographers on CO2 image quality (Ri = 0.80) and good agreement on diagnosis (k = 0.62). In 91% of the vein segments evaluated with C02 there was interobserver agreement on the diagnosis. Upper extremity veins were adequately imaged with CO2 alone in all (6/6) patients with contraindications to iodinated contrast. Following suboptimal iodinated contrast studies in six patients, CO2 produced significantly better quality upper extremity central vein images (p < 0.05). Pain following injection into peripheral veins was the only CO2-related complication. Inferior vena cava (IVC) filters were successfully deployed with CO2 alone in 78% (7/9) of patients; two required iodinated contrast.


CONCLUSIONS
Based upon initial experience, CO2 venography can be recommended in patients with contraindications to iodinated contrast or unsatisfactory iodinated contrast studies.
Sullivan
K L
KL
Department of Radiology, Thomas Jefferson University Hospital/JeffersonMedical College, Philadelphia, PA 19107, USA.
Bonn
J
J
Shapiro
M J
MJ
Gardiner
G A
GA
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001132:Arm / Q000098:blood supply; D002245:Carbon Dioxide / Q000009:adverse effects; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010146:Pain / Q000209:etiology; D010690:Phlebography / Q000009:adverse effects; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging
D003287:Contrast Media; D002245:Carbon Dioxide