Carbon dioxide gas as an arterial contrast agent

To investigate the clinical utility of CO2 gas as an arterial contrast agent, the experience with CO2 arteriography at the University of Florida was reviewed.

Preliminary studies have demonstrated the feasibility of CO2 arteriography and shown that arterial injection of CO2 gas appears non-toxic (which could limit the risks of contrast induced renal injury and allergic reaction). However, numerous technical problems make CO2 arteriography a demanding technique and recent studies have suggested that distal lower extremity vessels are difficult to image using CO2 arteriography, especially when significant arterial occlusive disease is present.

One hundred twenty-eight CO2 arteriograms done in 115 patients were reviewed. CO2 arteriograms were graded as excellent, good, poor, or inadequate by two blinded observers and results of CO2 studies compared to results of standard contrast studies (done in 98 patients for image comparison). In addition, a therapeutic plan based on the CO2 arteriograms was compared with the therapy each patient received.

One hundred-seventeen (91%) of the CO2 arteriograms were of good or excellent quality and agreement between CO2 studies and standard contrast studies was seen in 93 of 98 cases (95%). Accurate therapeutic plans based on CO2 studies were possible in 92% of cases with inadequate visualization of infrapopliteal arteries being the major limitation (7 cases). No allergic reactions occurred and only one patient potentially had contrast-induced nephrotoxicity.

CO2 arteriography provides accurate, clinically useful arterial imaging with minimal risk. Thus, this new technology significantly increases the utility of arteriography in patients with peripheral vascular disease.