Main fields of Application
The following section shows information extracted from the scientific literature on carbon dioxide angiography.
As is increasingly demonstrated, the use of CO2 as a Contrast Agent can bring considerable advantages in many types of intervention in the field of Interventional Cardiology, Interventional Radiology, Interventional Angiology and Vascular Surgery.
Because of its Gas Properties, Carbon Dioxide infact can be injected into each lumen structure (arterial, venous, biliary tract, abscesses, fistulas) below the diaphragm.
CARBON DIOXIDE MAIN TECHNICAL FEATURES
- Eliminate CIN risk
- No allergic reaction
- No tossic, no renal complications
- 20 times more soluble than O2 in the blood
- 400 times less viscous than iodine
- Fast and natural removal by normal breathing through lungs
- Lower price than the common liquid contrast medium
- Much more comfort for the patient
CO2 ANGIOGRAPHY INDICATIONS
- Renal failure diabetes
- Intolerance to iodinated contrast
Creatinine greater than 1.8 mg/dl
CO2 DIAGNOSIS APPLICATION
- Pelvic arteries
- Lower limbs: iliac, femoral, popliteal, tibial and foot arteries.
- Renal, visceral arteries
- Venous system
CO2 INTERVENTIONAL APPLICATION
- Stent placement
- Shunt for hemodialysis
- Vena cava filter placement
- Ablation of renal artery
- Transcatheter embolization
- Endovascular treatment of abdominal aortic aneurysm
Therapeutic indications to the use of CO2 in angiographyThe Estimated Glomerular Filtration Rate (eGFR, measured in mL/min/1.73m2) is an indicator of kidney function, and is the most important clinical parameter in evaluating the use CO2 as contrast media in angiography. In addition, other risk factors must be taken into consideration. Albuminuria is an important factor, as it influences the therapeutic indications.
- Mehran, R., and E. Nikolsky. “Contrast-induced nephropathy: definition, epidemiology, and patients at risk.” Kidney International 69 (2006): S11-S15.
- Kroneberger, Christian, et al. “Contrast-induced nephropathy in patients with chronic kidney disease and peripheral arterial disease.” Acta radiologica 4.6 (2015).
- Cho KJ. “Carbon Dioxide Angiography: Scientific Principles and Practice”, Vascular Specialist International, 2015.
- Palena M. Luis, et al, “Automated Carbon Dioxide Angiography for the Evaluation and Endovascular Treatment of Diabetic Patients with Critical Limb Ischemia”, Journal of Endovascular Therapy.
- Scalise F, et al, “ Commentary: Carbon Dioxide Automated Angiography in Patients With a High Risk of Contrast-Induced Nephropathy who undergo Percutaneous Interventions for Critical Limb Ischemia.”, Journal Of Invasive Cardiology (2015)
- Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease
- J.G. Caridi, et al. “Carbon Dioxide Digital Subtraction Angiography (CO2 DSA): A Comprehensive User Guide for All Operators”, Vascular Disease Managament 2014;11(10):E221-E256
- A. Giordano, S. Messina, et al. “Peripheral diagnostic and interventional procedures using an automated injection system for carbon dioxide (CO2): case series and learning curve”, Heart Lung Vessel. 2015;
- I. Corazza, et al. “Mechanical aspects of CO2 angiography”, Physica Medica (2011)
Example of procedures that take advantage of the use of CO2 gas as contrast media
TIPS: using CO2 for the localization of the portal vein can facilitate this procedure. The lowest viscosity of the gas than the iodinate contrast media permits to visualize more clearly the portal vein.
EVAR: during this procedure are performed many angiography but patients undergoing this procedure are often elderly with compromised renal function; using CO2 instead of iodine can reduce risk of contrast induced nefropathy risk for patients.
Acute intestinal hemorrhage detection: CO2 can help in this procedure because the gas in the intestine expand in a peculiar way creating caracteristic bubbles that reveal the bleeding.
Detection of Endoleaks following EVAR: the low viscosity of CO2 than iodine (400 times less viscous) allows to much more easily identify the endoleaks with an angiography performed with the gas as cntrast media.
Interventions in the peripheral arteries and in in upper and lower limbs: CO2 can be more effective than the iodinate contrast media because in this kind of investigation it permits to have a more accurate visualization of the arteries and vein.