Vascular Imaging with Carbon Dioxide: Confidence in a Safe, Efficacious, User-Friendly System

Carbon dioxide (CO2) has been used as an imaging agent since the early 1900s. The intravascular use of CO2 for imaging began in the 1960s. Its use was limited, as the available technology for imaging and safe delivery was poor. Even until today its use as an imaging agent has not reached its potential because of non-user friendly and cumbersome delivery methods. Confusing tanks, valves, and assembly of do-it-yourself systems create an aversion to its use. As an invisible agent with properties vastly different from liquid contrast, well-seasoned interventionalists are hesitant to use it because of perceived often unrealistic potential complications. Despite many of the advantages of a gaseous imaging agent, insecurity has translated to its lack of use and availability to the benefit of patients. With the development of the new CO2mmander/AngiAssist delivery system (AngioAdvancements, Inc; Ft. Meyers, FL), a compact, unwieldy, easily understood, closed system that does not require assembly is replacing the various makeshift systems in the CO2 community. This system combines a small multiuse disposable cylinder, compact regulator, and a dual syringe delivery system to the patient. A unique proprietary valve (K-valve) prevents the possibility of CO2 overload during delivery. Because of one-way valves and the prepackaged complete setup, operator error and air contamination with inadvertent connections are eliminated. Noncompressed CO2 is administered in the volume of choice in a nonexplosive manner. This simple, yet safe and effective, delivery system will undoubtedly promote the greater use of intravascular CO2. This in turn will translate into improved patient care in both the diagnostic and interventional arena.