CO2 Angiography-1

Park, Jang Sang

Abstract

CO2 was firstly used as an intravenous contrast medium in the early 1950s for diagnosing pericardial effusion. In the 1970s Cho and Hawkins pioneered the intraarterial use of CO2. In 1980, with the appearance of digital subtraction angiography (DSA), excellent imaging of "low density" contrast material was available. CO2 can be used very safely not only in patients with contrast allergies and renal failure, but also in patients undergoing routine angiographic evaluations and many interventional procedures. Nowadays, conventional invasive vascular imaging is being replaced by high-technology imaging modalities, including ultrasound, computed tomography, and magnetic resonance angiography (MRA): however, angiography continues to be the gold common procedure. Gadodiamide has been proposed to replace iodinated contrast material in high-risk patients with contrast allergy and renal insuffieciency. Neither nonionic iodinated contrast medium nor gadolinium-based contrast medium is safe, because these contrast medium may cause allergic reactions or nephrotoxicity. In recent years, its gadolinium-containing contrast agents have been shown to cause nephrogenic systemic fibrosis in patients with end-stage renal disease. Therefore, the use of carbon dioxide as a contrast agent has increased significantly with its wide clinical applications, including the use of carbon dioxide during peripheral vascular stenting and abdominal aortic stent graft placement. Familiarity with the physical properties of carbon dioxide, avoidance of air contamination, catheterization techniques, vascular anatomy, physiologic monitoring, and radiation safety is essential for the safe and effective performance of carbon dioxide angiography. Recently, CO2 has been reported as a "black blood" contrast agent for MRA. Today, carbon dioxide is used worldwide as a contrast agent for numerous vascular and nonvascular procedures in various organs and arterial circulation below the diagram, as well as in the venous circulation. There are over 200 publications proving that CO2 is not nephrotoxic and is without any kind of allergy. For safe and reliable utilization, one must understand the principles of CO2 delivery in the vascular system. A very safe and inexpensive plastic bag delivery system (CO2 Plastic Bag Delivery System(TM), AngioDynamics, Inc., USA) has been used during the over past 20 years. High-resolution DSA 1024x1024 systems with high frame rates have produce images nearly comparable to those with iodinated contrast material.