Balloon-Occluded Carbon Dioxide Gas Angiography for Internal Iliac Arteriography and Intervention
The usefulness of carbon dioxide (CO2) gas digital subtraction angiography (DSA) has been reported for patients with renal insufficiency and allergy to iodinated contrast agents. However, CO2 gas cannot replace the iodinated contrast agent in all cases owing to some disadvantages. We describe balloon-occluded CO2 DSA (B-CO2 DSA) as an improved CO2 DSA procedure for interventions in the internal iliac artery (IIA) region and compare the quality of images obtained using conventional CO2 DSA and B-CO2 DSA.
Materials and Methods
B-CO2 DSA-guided embolization was performed for one case of genital bleeding with an acute anaphylactic reaction to the iodinated contrast agent and for three cases of type II endoleaks after endovascular abdominal aortic aneurysm repair with renal dysfunction. A 9-mm occlusion balloon catheter was placed just after the orifice of the IIA. Then, 10–15 ml of CO2 gas was injected manually via the catheter with and without balloon occlusion. The quality of sequential digital subtraction angiograms was analyzed based on a scoring criterion.
In all four cases, image quality was improved with B-CO2 DSA; the poor quality of images without balloon occlusion was because of reflux of the CO2 gas.
B-CO2 DSA improves the image quality of CO2 DSA in the IIA region and is useful for vascular intervention.
Level of Evidence
KeywordsCarbon dioxide gas Balloon-occluded digital subtraction angiography Anaphylactic reaction Renal dysfunction Internal iliac artery Endoleak
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Fujihara M, Kawasaki D, Shintani Y, Fukunaga M, Nakama T, Koshida R, et al. Endovascular therapy by CO2 angiography to prevent contrast-induced nephropathy in patients with chronic kidney disease: a prospective multicenter trial of CO2 angiography registry. Catheter Cardiovasc Interv. 2015;85:870–7.CrossRefPubMedGoogle Scholar