CARBON-DIOXIDE DIGITAL SUBTRACTION ARTERIOGRAPHY-ASSISTED TRANSLUMINAL ANGIOPLASTY

During a 62-month period, carbon dioxide was used to supplement or com pletely replace iodinated contrast agents in performing 27 translumina l angioplasties in 26 patients. The arterial segments addressed includ ed 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 u lceration in 10, rest pain in three, claudication in one, and ischemic nephropathy in two. Contraindications to iodinated contrast agents in cluded renal insufficiency resulting from diabetes (n = 20) or ischemi c nephropathy (n = 2) and congestive heart failure (n = 4). Eight proc edures used carbon dioxide as the sole contrast agent, whereas 19 requ ired supplementation of carbon dioxide with a mean of 39 ml of nonioni c contrast medium. Technical success was achieved in 25 procedures wit h significant hemodynamic improvement in 20 patients. Complications in cluded transient deterioration in renal function in two patients and m yocardial 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 us ing carbon dioxide/digital subtraction arteriography to reduce or elim inate the need for iodinated contrast agents.