Carbon dioxide angiography of the lower limbs: initial experience with an automated carbon dioxide injector

Carbon dioxide (CO2) has been used as an arterial contrast agent since 1971. The development of digital subtraction angiography and an automated CO2 injector has increased the practicability and safety of using CO2 routinely. Sixty-three patients had lower limb and/or renal arteriograms performed over a 6-month period using CO2 in comparison with iodinated contrast medium. The majority (mean 74%, range 53-86%) of non-selective studies were diagnostic to the level of the popliteal artery, and 84% of selective lower limb studies were diagnostic. No serious complications occurred. The contrast and spatial resolution of CO2 digital subtraction arteriography (CO2DSA) was not consistently as good as iodinated contrast medium in peripheral lower limb or renal studies. However, due to the absence of allergic reactions and lack of nephrotoxicity, CO2 is a diagnostic alternative to iodinated contrast medium in selected patients.