Main Fields Of Application

The following section shows information extracted from the scientific literature on carbon dioxide angiography. See References below.

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Therapeutic Indications To The Use Of CO2 In Angiography

The Estimated Glomerular Filtration Rate (eGFR, measured in mL/min/1.73m2) is an indicator of renal function, and represents the most important clinical parameter in evaluating the CO2 use as contrast media in angiography. Other risk factors must be taken into consideration, i.e.: Albuminuria which influences the therapeutic indications.

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Angiodroid Advantages

Why the use Angiodroid The CO2 Injector is recommended in particular procedures

St. Franziskus Hospital, Munster (GER)_Dr Martin Austermann

EVAR – Endovascular Aneurysm Repair

EVAR procedures - usually time consuming, performed on elderly people with already compromised renal function cardiovascular risks and comorbidities and operators - may need multiple acquisitions with a consequent important use of iodinated contrast medium. Thanks to the use of Angiodroid The CO2 Injector, it is possible to limit the total amount of the iodine to few millilitres

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Interventions In The Peripheral Arteries 

Throughout the use of Angiodroid the CO2 injector it is possible to perform selective injections with regulated amount of both volume and pressure which allow operators to visualize all the peripheral district with an accurate visualization of both arteries and veins.

The low viscosity of the CO2 can provide complementary information to standard iodinated contrast media, hence helping operators in the decision-making process.

Auckland Hospital (NZL) post stent

Venous System

CO2 can be applied during phlebography or interventions on the fistulae of already dialyzed patients. The use of CO2 would ensure a total preservation of the residual renal function of the patients.

The localization of the perfect site for the portal-hepatic vein connection can be facilitated using Angiodroid The CO2 Injector during Transjugular Intrahepatic Portosystemic Shunt (TIPS). In fact, the low viscosity of the CO2 allows the counter flow spread from the portal vein to the hepatic vein, moreover reducing the CIN risk and preserving the patient’s renal function.

Klinikum Chemnitz (GER)_Type I Endoleak_dr. Seifert

Detection Of Endoleaks Following EVAR

Thanks to the low viscosity of the CO2 the detection of type II endoleaks is easy, safe and more efficient than the standard technique.

In a study conducted by Mascoli et al. on 21 patients undergoing EVAR procedure, CEUS and ICM-Angiography showed a poor agreement (Cohen’s 𝐾: 0.35) while CEUS and CO2-Angiography showed a substantial agreement (Cohen’s 𝐾: 0.65) for type II endoleak detection. A perfect agreement between CEUS and both ICM-Angiography and CO2-Angiography was observed for type I/III endoleak (Cohen’s 𝐾: 1).

 

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Acute Intestinal Hemorrhage Detection

Angiodroid The CO2 Injector facilitate the hemorrhage detection as the automated CO2 delivery creates characteristics bubbles that, joined to the CO2 low viscosity, privilege low pressure paths and therefore are able to reveal the bleeding region.

 

Angiodroid Applications

When the use Angiodroid The CO2 Injector is safe and effective

The use of CO2 as a Contrast Agent has been demonstrated to provide considerable advantages in many types of intervention and in different fields, i.e. Vasculas Surgery, Interventional Radiology and Interventional Angiology.

Carbon Dioxide is fully biocompatible for the human body and can be injected into any lumen structure below the diaphragm (arterial, venous, biliary tract, abscesses, fistulas). All patients undergoing a peripheral angiography procedure can benefice from the Carbon Dioxide use, and it is especially indicated for patients with renal failure, diabetes, intolerance to iodinated contrast media, and creatinine higher than 1.5 mg/dl.

Carbon Dioxide Properties
  • Eliminate CIN risk
  • No allergic reaction
  • No toxicity, renal function is fully preserved
  • 20 times more soluble than O2 in the blood
  • 400 times less viscous than iodine
  • Fast and natural removal by normal breathing
  • Lower price than the common ICM
  • No maximum dosage of injected CO2 per procedure
  • Much more comfort for the patient
Germany, Universitätsklinikum Düsseldorf_Artis Knapsis_PhilipsAzurion2
Why choose Angiodroid The CO2 Injector
Angiodroid The CO2 injector has solved three critical problems on the CO2 usage
  • Air contamination: every time the injector is switched on an automatic check of all the internal circuit is performed to detect unwanted air leakage and avoid any risk of air contamination and vascular embolism
  • CO2 dosage: inject the correct dose of CO2 to obtain the optimal image
  • Pressure of injection: inject the gas using a constant pressure to reduce the patients’ discomfort
Angiodroid The CO2 injector technical improvements have made the CO2 delivery:
Save and reliable. By controlling both volume and pressure of injection, it is possible to standardize procedures with unique patients’ specific protocols that surgeons can personally design.
Easy and fast. The injector is ready to inject in less than 10 seconds from the previous injection using a touchscreen or the remote controller which can be used from the control room to reduce the X-ray dose of the surgeon and its team. It is also possible using certain C-arm Angiography to synchronize the CO2 injection with the X-rays emission in order to optimize the image quality and reduce the patients’ radiation dose.
 

Diagnostic Applications

  • Pelvic arteries
  • Lower limbs: iliac, femoral, popliteal, tibial and foot arteries.
  • Renal, visceral arteries
  • Venous system
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Interventional Applications

  • Angioplasty
  • Stent placement
  • Shunt for haemodialysis
  • Vena cava filter placement
  • Ablation of renal artery
  • Transcatheter embolization
  • Endovascular treatment of abdominal aortic aneurysm
Abano Terme - Manzi - nov2019

References

  • 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)
  • Manzi M, et al. “CO2 Angiography in Diabetic Critical Limb Ischemia Patients” Endovascular Today(2017)
  • Mascoli C., et al. “Standardization of a carbon dioxide automated system for endovascular aortic aneurysm repair”, Ann. Vasc. Surg. (2018)
  • Mascoli C., et al. “Endovascular treatment of a severe calcified popliteal artery lesion by endovascular lithoplasty and drug-coated balloon angioplasty in a patient with critical limb ischemia and chronic kidney disease”, Contras. Med. Vasc. Imaging (2018)
  • Castriota F., et al. “Contrast-Zero Transcatheter Aortic Valve Replacement for Patients With Severe Renal Dysfunction” (2018)
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