CARBON-DIOXIDE AS A CONTRAST AGENT TO GUIDE VASCULAR INTERVENTIONAL PROCEDURES

OBJECTIVE, The purpose of this study was to assess the value and limit ations of carbon dioxide (CO2) as a contrast agent to guide vascular i nterventional procedures. SUBJECTS AND METHODS. Twenty-two adults unde rwent 26 vascular interventional procedures (21 arterial, five venous) . We aimed to use only CO2 if possible because these patients had rena l insufficiency (n = 21; mean creatinine level, 2.8 mg/dl) or were all ergic to contrast material (n = 1). Arterial procedures performed incl uded renal angioplasty or stent (n = 6), iliac angioplasty or stent (n = 5), infrainguinal angioplasty (II = 5), arterial bypass graft angio plasty (n = 3), and thrombolysis (n = 2). Venous procedures included t ransjugular intrahepatic portosystemic shunt recanalization (n = 3), a ngioplasty of the venous anastomosis of a thigh dialysis graft (n = 1) , and angioplasty of the inferior vena cava (n = 1). RESULTS. Twenty-f ive of the 26 procedures were successfully performed. Of the 26 proced ures , eight required no iodinated contrast material and I 1 required less than or equal to 20 mi of contrast material. CO2 proved to be ina dequate for the remaining seven procedures. Iliac artery angioplasty o r stent placement required an average of 9 mi of iodinated contrast ma terial; infrainguinal angioplasty required an average of 22 mi of iodi nated contrast material. CONCLUSION, CO2 can be successfully used as a contrast agent in a variety of vascular interventional procedures. Su ch procedures can usually be performed in the iliac and infrainguinal arteries using minimal supplemental iodinated contrast material. Howev er, CO2 failed to provide satisfactory guidance in half of the intraab dominal procedures in our study.