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Balloon-Occluded Carbon Dioxide Gas Angiography for Internal Iliac Arteriography and Intervention

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Abstract

Introduction

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.

Results

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.

Conclusions

B-CO2 DSA improves the image quality of CO2 DSA in the IIA region and is useful for vascular intervention.

Level of Evidence

Level IV.

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Authors and Affiliations

  1. Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Mitsuhiro Kishino, Shuichiro Nakaminato, Yoshio Kitazume, Yukihisa Saida & Ukihide Tateishi

  2. Department of Perinatal and Women’s Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Naoyuki Miyasaka

  3. Division of Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan

    Toshifumi Kudo

Authors
  1. Mitsuhiro Kishino
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  2. Shuichiro Nakaminato
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  3. Yoshio Kitazume
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  4. Naoyuki Miyasaka
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  5. Toshifumi Kudo
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  6. Yukihisa Saida
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  7. Ukihide Tateishi
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Corresponding author

Correspondence to Mitsuhiro Kishino.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

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

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Kishino, M., Nakaminato, S., Kitazume, Y. et al. Balloon-Occluded Carbon Dioxide Gas Angiography for Internal Iliac Arteriography and Intervention. Cardiovasc Intervent Radiol 41, 1106–1111 (2018). https://doi.org/10.1007/s00270-018-1957-5

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  • DOI: https://doi.org/10.1007/s00270-018-1957-5

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