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Carbon Dioxide Angiography as a Sole Contrast Modality in Endovascular Procedures
Yibo Sun1, Yuan Shen1, Yongzhi Wang2
1HuZhou Central Hospital, Affiliated Huzhou Hospital, Zhejiang University School of Medicine.
Annals of Vascular Surgery
|August 10, 2026
Summary
Carbon dioxide (CO2) angiography is a safe and effective alternative contrast agent for endovascular procedures, especially for patients with kidney issues or allergies to iodinated contrast medium (ICM). This study shows high technical success and no significant impact on renal function.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Nephrology
Background:
- Iodinated contrast medium (ICM) poses risks like allergic reactions and post-contrast acute kidney injury (PC-AKI).
- Carbon dioxide (CO2) angiography is a promising alternative for patients with renal insufficiency or ICM allergy.
- Limited regional data exists on CO2 angiography's efficacy and safety.
Purpose of the Study:
- To evaluate the accuracy and safety of CO2 as the sole contrast modality in regional endovascular procedures.
- To provide region-specific data on CO2 angiography for patients with contraindications to ICM.
Main Methods:
- Retrospective analysis of clinical data from 28 patients undergoing endovascular procedures using CO2 angiography alone.
- Primary endpoint: technical success.
- Secondary endpoints: postoperative renal function and complication incidence.
Main Results:
- Technical success rate was 92.86% (26/28 cases).
- No statistically significant difference in serum creatinine (sCr) levels pre- and post-procedure.
- No CO2-related complications occurred; two patients required adjunctive ICM for suboptimal imaging.
Conclusions:
- CO2 angiography is a feasible and safe alternative for specific endovascular procedures, especially in high-risk patients.
- Larger prospective studies are needed to confirm these findings before widespread adoption.