Skip to main content
SpringerLink
Log in

The Current Status of the Use of Carbon Dioxide in Diagnostic and Interventional Angiographic Procedures

  • REVIEW ARTICLES
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Since the first description of carbon dioxide (CO2) angiography the indications for using CO2 have been changing and the applications of CO2 angiography evolving. This review covers the contemporary role of CO2 angiography. CO2 angiography can be considered according to whether it is likely to be better, equivalent to or worse than conventional iodinated contrast medium (ICM). Areas where CO2 angiography offers distinct advantages over ICM will be emphasized. The limitations to using CO2 and specific caveats will be discussed. The basic physical properties of CO2 and avoidance of the complications of gas angiography will be considered. CO2 gas is cheap, non-allergenic, and is not nephrotoxic. Unfortunately it is not a panacea, angiographic quality is reduced, it is not tolerated by every patient, and it cannot be used in every location. It is important to be pragmatic and to use conventional contrast or alternative imaging rather than struggling with suboptimal CO2 angiography.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6

Similar content being viewed by others

References

  1. Hawkins IF (1982) Carbon dioxide digital subtraction arteriography. AJR Am J Roentgenol 139:19–24

    CAS  PubMed  Google Scholar 

  2. Carllei HH SE (1921) A new procedure for examining the kidney. Rev Asoc Med Argentina 34:18–24

    Google Scholar 

  3. Bendib M, Toumi M, Boudjellab A (1977) [CO2 angiography and enlarged CO2 angiography in cardiology (author’s transl.)]. Ann Radiol (Paris) 20:673–686

    CAS  Google Scholar 

  4. Aspelin P, Aubry P, Fransson SG, Strasser R, Willenbrock R, Berg KJ (2003) Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med 348:491–499

    Article  CAS  PubMed  Google Scholar 

  5. Lumb A, Nunn JF (2000) Nunn’s applied respiratory physiology, 5th edn. Butterworth-Heinemann, Boston Oxford

    Google Scholar 

  6. Seeger JM, Self S, Harward TR, Flynn TC, Hawkins IF Jr (1993) Carbon dioxide gas as an arterial contrast agent. Ann Surg 217:688–697; discussion 697–698

    CAS  PubMed  Google Scholar 

  7. Hawkins IF Jr, Mladinich CR, Storm B, Croker BP, Wilcox CS, Akins EW, et al. (1994) Short-term effects of selective renal arterial carbon dioxide administration on the dog kidney. J Vasc Interv Radiol 5:149–154

    PubMed  Google Scholar 

  8. Kessel DO, Robertson I, Patel Jr, Peters K, Taylor EJ, Denton LJ, et al. (2002) Carbon-dioxide-guided vascular interventions: Technique and pitfalls. Cardiovasc Intervent Radiol 25:476–483

    PubMed  Google Scholar 

  9. Cronin P, Patel JV, Kessel DO, Robertson I, McPherson SJ (2005) Carbon dioxide angiography: A simple and safe system of delivery. Clin Radiol 60:123–125

    Article  CAS  PubMed  Google Scholar 

  10. Back MR, Caridi JG, Hawkins IF Jr, Seeger JM (1998) Angiography with carbon dioxide (CO2). Surg Clin North Am 78:575–591

    Article  CAS  PubMed  Google Scholar 

  11. Snow TM, Rice HA (1999) A simple gas injector for carbon dioxide angiography. Clin Radiol 54:842–844

    Article  CAS  PubMed  Google Scholar 

  12. Diaz LP, Pabon IP, Garcia JA, de la Cal Lopez MA (2000) Assessment of CO2 arteriography in arterial occlusive disease of the lower extremities. J Vasc Interv Radiol 11:163–169

    CAS  PubMed  Google Scholar 

  13. Hawkins IF, Caridi JG (1998) Carbon dioxide (CO2) digital subtraction angiography: 26-year experience at the University of Florida. Eur Radiol 8:391–402

    Article  CAS  PubMed  Google Scholar 

  14. Coffey R, Quisling RG, Mickle JP, Hawkins IF Jr, Ballinger WB (1984) The cerebrovascular effects of intraarterial CO2 in quantities required for diagnostic imaging. Radiology 151:405–410

    CAS  PubMed  Google Scholar 

  15. Ehrman KO, Taber TE, Gaylord GM, Brown PB, Hage JP (1994) Comparison of diagnostic accuracy with carbon dioxide versus iodinated contrast material in the imaging of hemodialysis access fistulas. J Vasc Interv Radiol 5:771–775

    CAS  PubMed  Google Scholar 

  16. Caridi JG, Hawkins IF Jr (1997) CO2 digital subtraction angiography: Potential complications and their prevention. J Vasc Interv Radiol 8:383–391

    CAS  PubMed  Google Scholar 

  17. Spinosa DJ, Matsumoto AH, Angle JF, Hagspiel KD, Hooper TN (1998) Transient mesenteric ischemia: A complication of carbon dioxide angiography. J Vasc Interv Radiol 9:561–564

    CAS  PubMed  Google Scholar 

  18. Krajina A, Lojik M, Chovanec V, Raupach J, Hulek P (2002) Wedged hepatic venography for targeting the portal vein during TIPS: Comparison of carbon dioxide and iodinated contrast agents. Cardiovasc Intervent Radiol 25:171–175

    Article  PubMed  Google Scholar 

  19. Semba CP, Saperstein L, Nyman U, Dake MD (1996) Hepatic laceration from wedged venography performed before transjugular intrahepatic portosystemic shunt placement. J Vasc Interv Radiol 7:143–146

    CAS  PubMed  Google Scholar 

  20. Sandhu C, Buckenham TM, Belli AM (1999) Using CO2-enhanced arteriography to investigate acute gastrointestinal hemorrhage. AJR Am J Roentgenol 173:1399–1401

    CAS  PubMed  Google Scholar 

  21. Bush RL, Lin PH, Bianco CC, Lumsden AB, Gunnoud AB, Terramani TT, et al. (2002) Endovascular aortic aneurysm repair in patients with renal dysfunction or severe contrast allergy: Utility of imaging modalities without iodinated contrast. Ann Vasc Surg 16:537–544

    Article  PubMed  Google Scholar 

  22. Gahlen J, Hansmann J, Schumacher H, Seelos R, Richter GM, Allenberg JR (2001) Carbon dioxide angiography for endovascular grafting in high-risk patients with infrarenal abdominal aortic aneurysms. J Vasc Surg 33:646–649

    Article  CAS  PubMed  Google Scholar 

  23. Solomon R (1998) Contrast-medium-induced acute renal failure. Kidney Int 53:230–242

    Article  CAS  PubMed  Google Scholar 

  24. Kessel DO, Robertson I, Taylor EJ, Patel JV (2003) Renal stenting from the radial artery: A novel approach. Cardiovasc Intervent Radiol 26:146–149

    PubMed  Google Scholar 

  25. Caridi JG, Stavropoulos SW, Hawkins IF Jr (1999) Carbon dioxide digital subtraction angiography for renal artery stent placement. J Vasc Interv Radiol 10:635–640

    CAS  PubMed  Google Scholar 

  26. Kerns SR, Hawkins IF Jr (1995) Carbon dioxide digital subtraction angiography: Expanding applications and technical evolution. AJR Am J Roentgenol 164:735–741

    CAS  PubMed  Google Scholar 

  27. Gorriz E, Carreira JM, Reyes R, Gallardo L, Pulido JM, Romero A, et al. (1999) CO2 as a contrast medium in endoluminal treatment of high flow vascular malformations. Eur J Radiol 31:182–187

    CAS  PubMed  Google Scholar 

  28. Oliva VL, Denbow N, Therasse E, Common AA, Harel C, Giroux MF, et al. (1999) Digital subtraction angiography of the abdominal aorta and lower extremities: Carbon dioxide versus iodinated contrast material. J Vasc Interv Radiol 10:723–731

    CAS  PubMed  Google Scholar 

  29. Bees NR, Beese RC, Belli AM, Buckenham TM (1999) Carbon dioxide angiography of the lower limbs: Initial experience with an automated carbon dioxide injector. Clin Radiol 54:833–888

    Article  CAS  PubMed  Google Scholar 

  30. Frankhouse JH, Ryan MG, Papanicolaou G, Yellin AE, Weaver FA (1995) Carbon dioxide/digital subtraction arteriography-assisted transluminal angioplasty. Ann Vasc Surg 9:448–452

    Article  CAS  PubMed  Google Scholar 

  31. Eschelman DJ, Sullivan KL, Bonn J, Gardiner GA Jr (1998) Carbon dioxide as a contrast agent to guide vascular interventional procedures. AJR Am J Roentgenol 171:1265–1270

    CAS  PubMed  Google Scholar 

  32. Dewald CL, Jensen CC, Park YH, Hanks SE, Harrell DS, Peters GL, et al. (2000) Vena cavography with CO2 versus with iodinated contrast material for inferior vena cava filter placement: A prospective evaluation. Radiology 216:752–757

    CAS  PubMed  Google Scholar 

  33. Englander MJ, Siskin GP, Dowling K, Quarfordt S (2002) Uterine fibroid embolization without the use of iodinated contrast material. J Vasc Interv Radiol 13:427–429

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. St. James’s University Hospital, Beckett Street, Leeds, LS9 7TF, UK

    David Richard Shaw & David Oliver Kessel

Authors
  1. David Richard Shaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Oliver Kessel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Oliver Kessel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shaw, D.R., Kessel, D.O. The Current Status of the Use of Carbon Dioxide in Diagnostic and Interventional Angiographic Procedures. Cardiovasc Intervent Radiol 29, 323–331 (2006). https://doi.org/10.1007/s00270-005-0092-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-005-0092-2

Keywords

Search

Navigation