Carbon-dioxide-guided vascular interventions: technique and pitfalls.
OBJECTIVE
To evaluate the usefulness of carbon dioxide (CO2) angiography to guide vascular interventions.


METHODS
A prospective study was carried out of 50 procedures (angioplasty, stenting, stent-grafting and embolization) using CO2 angiography. Indications for using CO2 were renal impairment, cardiac failure, previous reaction to conventional iodinated contrast, or likelihood of needing high doses of conventional contrast. CO2 was intended to be the sole contrast agent. The use of additional conventional contrast or gadolinium was recorded, as were procedural complications. Radiation dose was compared with similar procedures using conventional contrast.


RESULTS
Angiographic quality was satisfactory in 44 (88%) procedures and CO2 guidance was all that was required; in 6 (12%) cases adjunctive use of conventional contrast or gadolinium was necessary. Contrast doses were significantly reduced and there was a trend toward decreased radiation doses with CO2. There were two significant complications but only one related to the use of CO2.


CONCLUSIONS
CO2 angiography is well tolerated and can be successfully used to guide even complex vascular interventions. High-risk patients can be spared the risks of conventional contrast agents.
Department of Radiology, St James's University Hospital, The Leeds Teaching Hospitals, Beckett Street, Leeds LS9 7TF, UK. DKessel@compuserve.com
David O
DO
Kessel
Iain
I
Robertson
Jai
J
Patel
Kevin
K
Peters
Edward J
EJ
Taylor
Lucy J
LJ
Denton
Balbir
B
Bambhra
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000009:adverse effects / Q000379:methods; D000800:Angioplasty, Balloon; D002245:Carbon Dioxide / Q000009:adverse effects; D003287:Contrast Media / Q000009:adverse effects; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods; D015607:Stents; D014656:Vascular Surgical Procedures
D003287:Contrast Media; D002245:Carbon Dioxide