Total bowel ischemia after carbon dioxide angiography in a patient with inferior mesenteric artery occlusion

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Gastroenterology

Background:

• Endovascular stenting is a common treatment for peripheral artery disease.
• Carbon dioxide (CO2) angiography is utilized as an alternative to iodinated contrast media to mitigate the risk of contrast-induced nephropathy, particularly in patients with chronic renal failure.
• Atherosclerosis is a significant risk factor for peripheral artery disease and can affect multiple vascular beds.

Observation:

• A 70-year-old male patient with hypertension and chronic renal failure presented with claudication and underwent endovascular stenting of the left leg.
• CO2 angiography was employed during the procedure to avoid nephrotoxic contrast agents.
• Post-procedure, the patient developed livedo vasculitis and lactic acidosis, leading to a diagnosis of CO2-induced ischemic colitis.

Findings:

• Contrast-enhanced computed tomography revealed extensive bowel ischemia and complete occlusion at the origin of the inferior mesenteric artery.
• The rare complication of CO2-induced ischemic colitis was suspected.
• The findings suggest a potential association between CO2 angiography and atherosclerotic occlusion of the inferior mesenteric artery.

Implications:

• This case underscores a rare but serious complication associated with CO2 angiography.
• Clinicians should consider the possibility of CO2-induced ischemic colitis in patients presenting with abdominal symptoms after CO2 angiography, especially those with risk factors for atherosclerosis.
• Further investigation may be warranted to elucidate the precise mechanism linking CO2 angiography to mesenteric ischemia in the context of underlying atherosclerotic disease.