Carbon-Dioxide-Guided Vascular Interventions: Technique and Pitfalls

Purpose: To evaluate the usefulness of carbon dioxide (CO2) angiography to guide vascular interventions. Methods: A prospective study was carried out of 50 procedures (angioplasty, stenting, stent-grafting and embolization) using CO2 angiography. Indications for using CO2 were renal impairment, cardiac failure, previous reaction to conventional iodinated contrast, or likelihood of needing high doses of conventional contrast. CO2 was intended to be the sole contrast agent. The use of additional conventional contrast or gadolinium was recorded, as were procedural complications. Radiation dose was compared with similar procedures using conventional contrast. Results: Angiographic quality was satisfactory in 44 (88%) procedures and CO2 guidance was all that was required; in 6 (12%) cases adjunctive use of conventional contrast or gadolinium was necessary. Contrast doses were significantly reduced and there was a trend toward decreased radiation doses with CO2. There were two significant complications but only one related to the use of CO2. Conclusion: CO2 angiography is well tolerated and can be successfully used to guide even complex vascular interventions. High-risk patients can be spared the risks of conventional contrast agents.