To discuss the rationale of using of Carbon Dioxide (CO2) as a contrast agent in angiographic and vascular interventional procedures in patients with formal contraindications to Iodinated Contrast Medium (ICM). To illustrate chemical and physical properties of CO2 with the aim of its use as contrast agent,
outlining its value and limitations. To present some clinical cases in which CO2 angiography was performed.
Iodine contrast medium (ICM) is considered gold standard in endovascular procedures.
contrast-induced-nephrotoxicity and hypersensitivity to ICM may limit its use in endovascular procedures.
(1) In the general population,
the incidence of nephrotoxicity related to ICM is about 0.6-2.3% (4); patients with renal insufficiency or other risks factors (elderly age,
low cardiac ejection rate,
use of nephrotoxic drugs,
high volume of ICM needed for the...
Findings and procedure details
CO2 angiography has to be considered whenever possible in patients at risk of contrast nephrotoxicity or contrast reaction to ICM (3).
CO2 is indicated in patients with reduced renal function (serum creatinine > 1,5 g/dl) that must undergo diagnostic or therapeutic angiography.
It may also be used in combination with ICM in order to reduce the amount of ICM.
(2) (3) (22) Finally,
CO2 may be used in patients with cardiac failure that must undergo angiography.
(3) Patients can...
CO2 angiography is a feasible and safe procedure,
that can be successfully used to guide diagnostic angiography and interventional procedures.
(1) (2) (3) (21) This may be particularly usefull in patients with allergy to ICM or impaired renal function in order to avoid or reduce the use of ICM.
(16) (17) (20)
1) de Almeida Mendes C,
de Arruda Martins A,
Passos Teivelis M,
Wolosker N. Carbon dioxide is a cost-effective contrast medium to guide revascularization of TASC A and TASC B femoropopliteal occlusive disease. Ann Vasc Surg 2014 Aug; 28(6):1473-8. 2) Eschelman DJ,
Gardiner GA Jr.. Carbon Dioxide as a Contrast Agent to Guide Vascular Interventional Procedures. AJR 1998 Nov; 171:1265-1270. 3) Kessel DO,