Main Fields of Application
The following section shows information extracted from the scientific literature on carbon dioxide angiography. See References below.
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.
EVAR – Endo-Vascular Aneurism Repair
During EVAR, operators have to take many images of abdominal aorta district and for this reason a lot of iodinated contrast medium is used. Patients undergoing this kind of procedures are often elderly with compromised renal function. With the use of Angiodroid The CO2 Injector instead of standard ICM, it is possible to reduce the contrast induced nefropathy risk saving and the total amount of iodine can be few milliliters.
Interventions in the peripheral arteries and in in upper and lower limbs
Thanks to the precise CO2 injections, Angiodroid The CO2 Injector let the operator to see all the peripheral districts with an accurate visualization of arteries and veins. As CO2 is less viscous than iodine, with Angiodroid The CO2 Injector it is possible to see even better than with the standard iodinated contrast media.
TIPS – Transjugular Intrahepatic Portosystemic Shunt
During TIPS, the use of Angiodroid The CO2 Injector 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 and to save the renal function of the patient, reducing the CIN risk.
Detection of Endoleaks following EVAR
Thanks to the unique features of Angiodroid The CO2 Injector and the low viscosity of CO2, 400 times less viscous than iodinated contrast media, the endoleaks detecton is easy and safe, even more efficient compared to the standard technique.
Acute intestinal hemorrhage detection
When operators has to detect an acute intestinal hemorrhage, Angiodroid The CO2 Injector is capable to help the intervention as the CO2 delivered with this automated system expand in the intestine creating caracteristic bubbles that reveal the bleeding. This particular way of behaviour make the use of Angiodroid suitable for the bleeding detection.
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. It is especially indicated for patient with renal failer, diabetes, intolerance to iodinated constrad media, creatinine higher than 1.8 mg/dl
- 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
- Lower price than the common ICM
- Much more comfort for the patient
- Pelvic arteries
- Lower limbs: iliac, femoral, popliteal, tibial and foot arteries.
- Renal, visceral arteries
- Venous system
- Stent placement
- Shunt for hemodialysis
- Vena cava filter placement
- Ablation of renal artery
- Transcatheter embolization
- Endovascular treatment of abdominal aortic aneurysm
- 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)