title: Safety of carbon dioxide digital subtraction angiography.
abstract: OBJECTIVE
  Reports of fatality following carbon dioxide digital subtraction angiography (CO2-DSA) have raised concerns regarding its safety. This study reviews the safety of CO2-DSA.
  
  
  METHODS
  Single-institution retrospective review.
  
  
  METHODS
  Tertiary care teaching hospital in Los Angeles, California.
  
  
  METHODS
  A total of 951 patients who underwent 1007 CO2-DSA procedures during a 21-year period.
  
  
  METHODS
  Preprocedure and postprocedure creatinine values and periprocedural morbidity and mortality.
  
  
  RESULTS
  A total of 632 arterial CO2-DSA were performed; 527 were aortograms with or without extremity runoff; 100, extremity alone; and 5, pulmonary. Venous CO2-DSA included 187 inferior vena cavagrams, 182 hepatic or visceral, 5 extremity venograms, and 1 superior vena cavagram. Associated endovascular procedures were performed in 499 cases; 162 were arterial interventions including 62 endovascular aneurysm repairs, 53 visceral or renal percutaneous angioplasty with/without stent, 41 extremity percutaneous angioplasty with or without a stent, and 4 cases of thrombolysis or embolization; 176 caval filters, 98 transjugular intrahepatic portosystemic shunts, 54 transjugular liver biopsies, and 9 other venous interventions. The mean preprocedure creatinine level was 2.1 mg/dL; postprocedure, 2.1 mg/dL (P = .56). There were a total of 61 (6.1%) procedural complications including 4 (0.4%) mortalities. Two were procedure-related complications: 1, suppurative pancreatitis following aortogram; and 2, hepatic bleed following failed transjugular intrahepatic portosystemic shunts. Two were attributable to patient disease; 1, metastatic adenocarcinoma; and 2, refractory, end-stage cardiomyopathy.
  
  
  CONCLUSIONS
  Carbon dioxide digital subtraction angiography is a versatile technique that can be safely used for diagnostic and therapeutic endovascular procedures. Morbidity and mortality are acceptable with preservation of renal function. Thus, CO2-DSA is a safe alternative to iodinated contrast.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, CardioVascular Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Moos
authors.forename: Sung W
authors.initials: SW
authors.lastname: Ham
authors.forename: Sukgu M
authors.initials: SM
authors.lastname: Han
authors.forename: Wesley K
authors.initials: WK
authors.lastname: Lew
authors.forename: Hong T
authors.initials: HT
authors.lastname: Hua
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Hood
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Rowe
authors.forename: Fred A
authors.initials: FA
authors.lastname: Weaver
mesh_terms: D015901:Angiography, Digital Subtraction / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D001027:Aortography / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D002245:Carbon Dioxide; D002423:Cause of Death; D003287:Contrast Media; D003404:Creatinine / Q000097:blood; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006784:Hospitals, Teaching; D006801:Humans; D007677:Kidney Function Tests; D015141:Los Angeles; D061214:Patient Safety; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D002245:Carbon Dioxide; D003404:Creatinine