Abstract
During a 62-month period, carbon dioxide was used to supplement or completely replace iodinated contrast agents in performing 27 transluminal angioplasties in 26 patients. The arterial segments addressed included the following: renal in two cases, iliac in five, femoral/popliteal in 15, infrapopliteal in two, and combined in three. Indications for intervention included lower extremity gangrene in 11 cases, ischemic ulceration in 10, rest pain in three, claudication in one, and ischemic nephropathy in two. Contraindications to iodinated contrast agents included renal insufficiency resulting from diabetes (n = 20) or ischemic nephropathy (n = 2) and congestive heart failure (n = 4). Eight procedures used carbon dioxide as the sole contrast agent, whereas 19 required supplementation of carbon dioxide with a mean of 39 ml of nonionic contrast medium. Technical success was achieved in 25 procedures with significant hemodynamic improvement in 20 patients. Complications included transient deterioration in renal function in two patients and myocardial infarctions in two. At 30 days 18 patients had demonstrated significant clinical improvement. Patients at high risk for iodinated contrast-related complications may undergo transluminal angioplasty using carbon dioxide/digital subtraction arteriography to reduce or eliminate the need for iodinated contrast agents.
Similar content being viewed by others
References
Weaver FA, Pentecost MJ, Yellin AE. Clinical applications of carbon dioxide/digital subtraction arteriography. J Vasc Surg 1991;13:266–273.
Beck DH, McQuillan PJ. Fatal carbon dioxide embolism and severe hemorrhage during laparoscopic salpingectomy. Br J Anaesth 1994;72:243–245.
Duncan C. Carbon dioxide embolism during laparoscopy: A case report. J Am Assoc Nurse Anesth 1992;60:139–144.
DePlater RMH, Jones ISC. Non-fatal carbon dioxide embolism during laparoscopy. Anaesth Intens Care 1989;17:359–361.
Silverman SH, Mladinich CJ, Hawkins IF, et al. The use of carbon dioxide gas to displace flowing blood during angioscopy. J Vasc Surg 1989;10:313–317.
Smits PC, Post MJ, Velema E, et al. Percutaneous coronary and peripheral angioscopy with saline solution and carbon dioxide gas in porcine and canine arteries. Am Heart J 1991;122:1315–1322.
White JV, Haas KS, Comerota AJ. An alternative method of salvaging occluded suprainguinal bypass grafts with operative angioscopy and endovascular intervention. J Vasc Surg 1993;18:922–931.
Hawkins F. Carbon dioxide digital subtraction arteriography. Am J Roentgenol 1982;139:19–24.
Weaver FA, Pentecost MJ, Yellin AE. Carbon dioxide digital subtraction arteriography: A pilot study. Ann Vasc Surg 1990;4:437–441.
Seeger JM, Self S, Harward TRS, et al. Carbon dioxide gas as an arterial contrast agent. Ann Surg 1993;217:688–698.
Matsi PJ, Manninen HI, Vanninen RL, et al. Femoropopliteal angioplasty in patients with claudication: Primary and secondary patency in 140 limbs with 1–3 year follow-up. Radiology 1994;191:727–733.
Currie IC, Wakeley CJ, Cole SEA, et al. Femoropopliteal angioplasty for severe limb ischaemia. Br J Surg 1994;81:191–193.
Hunink MGM, Wong JB, Donaldson MC, et al. Patency results of percutaneous and surgical revascularization for femoropopliteal arterial disease. Med Decis Making 1994;14: 71–81.
Author information
Authors and Affiliations
Additional information
We thank Frances Harvey, RN, for her invaluable assistance in the preparation of this manuscript.
About this article
Cite this article
Frankhouse, J.H., Ryan, M.G., Papanicolaou, G. et al. Carbon dioxide/digital subtraction arteriography-assisted transluminal angioplasty. Annals of Vascular Surgery 9, 448–452 (1995). https://doi.org/10.1007/BF02143858
Issue Date:
DOI: https://doi.org/10.1007/BF02143858