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Clinical applications of carbon dioxide/digital subtraction arteriography
F A Weaver1, M J Pentecost, A E Yellin
1Department of Surgery, University of Southern California School of Medicine, Los Angeles.
Insights
Carbon dioxide arteriography offers a safe alternative for patients with contraindications to iodinated contrast agents. This diagnostic imaging enables successful arterial interventions for peripheral artery disease and aneurysms.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Diagnostic Imaging
Background:
- Iodinated contrast agents pose risks for patients with renal insufficiency, heart failure, or contrast hypersensitivity.
- Alternative contrast agents are needed for safe arteriography in high-risk patient populations.
Purpose of the Study:
- To evaluate the safety and efficacy of carbon dioxide/digital subtraction arteriography (CO2/DSA) in patients with contraindications to iodinated contrast.
- To assess the utility of CO2/DSA in guiding subsequent arterial interventions.
Main Methods:
- A retrospective review of 40 CO2/DSA studies performed over 18 months in 33 patients.
- Indications included lower extremity ischemia, severe hypertension with renal insufficiency, and arterial aneurysms.
- Interventions guided by CO2/DSA included bypass surgeries and percutaneous transluminal angioplasties.
Main Results:
- Diagnostic quality arteriograms were achieved using CO2, with supplemental dilute nonionic contrast in 11 studies.
- Successful arterial interventions were performed in 11 patients, including bypasses and angioplasties.
- Complications were infrequent and included transient renal function decline, myocardial infarction, and transient tachypnea/tachycardia.
Conclusions:
- Carbon dioxide/digital subtraction arteriography is a safe and effective alternative for patients at high risk of contrast-related complications.
- CO2/DSA facilitates successful arterial reconstruction and endovascular intervention in diverse vascular pathologies.
- This technique expands diagnostic and therapeutic options for patients with contraindications to conventional contrast agents.
Abstract:
During an 18-month period 33 patients in whom there were contraindications to the use of iodinated contrast arteriography underwent 40 carbon dioxide/digital subtraction arteriograms for lower extremity ischemia (19), severe hypertension and renal insufficiency (12), or arterial aneurysm (2). Contraindications to iodinated contrast agents included renal insufficiency, congestive heart failure, and contrast hypersensitivity. Sixteen aortic, 15 iliac-femoral-popliteal-tibial, five aorta-iliac-femoral and four aorta-iliac-femoral-popliteal-tibial carbon dioxide/digital subtraction arteriography studies were performed. In 11 studies, imaging of selected arterial segments required the addition of 10 to 60 ml of dilute nonionic contrast. Guided by carbon dioxide/digital subtraction arteriography studies four femoral-tibial bypasses, three aneurysmorrhaphies, two aortorenal bypasses, one aortofemoral bypass and one femoral-femoral bypass were successfully performed in 11 patients. In addition, carbon dioxide/digital subtraction arteriography directed angioplasties of the common iliac (4), superficial femoral (6), popliteal (3), or tibioperoneal trunk (1) were performed in 10 patients. Complications of carbon dioxide/digital subtraction arteriography included transient deterioration in renal function in three patients in whom 20 ml of nonionic contrast was used, a nonfatal myocardial infarction after a popliteal percutaneous transluminal angioplasty in one patient, and transient tachypnea and tachycardia during a carbon dioxide/digital subtraction arteriography study in one patient. Diagnostic arteriograms are obtainable using carbon dioxide as the contrast agent. Carbon dioxide/digital subtraction arteriography permits patients with symptomatic arterial disease at high risk for contrast related complications to safely undergo arteriography and subsequent arterial reconstruction or endovascular intervention.