Carbon Dioxide Angiography

The algorithm for patients with renal insufficiency who require vascular imaging has recently changed in my hospital. Previously, the majority of these patients underwent magnetic resonance angiography (MRA) or occasionally computed tomographic angiography after prescan hydration and sodium bicarbonate infusion. Although we have used carbon dioxide (CO₂) for many years, with the advent of nephrogenic systemic sclerosis and its unclear relationship to MRA contrast agents, we are increasingly using CO₂ as a contrast agent for both diagnosis and to guide therapy. CO₂ has been used for > 30 years. It is not nephrotoxic or hepatotoxic and is nonallergenic. It is also quite inexpensive compared with other contrast agents.

SUGGESTED READINGS

• 1 Hawkins I F, Caridi J G. Carbon dioxide (CO₂) digital subtraction angiography: 26-year experience at the University of Florida.  Eur Radiol. 1998;  8 391-402
• 2 Hawkins I F, Caridi J G, Klioze S D, Mladinich C R. Modified plastic bag system with O-ring fitting connection for carbon dioxide angiography.  AJR Am J Roentgenol. 2001;  176 229-232
• 3 Shaw D R, Kessel D O. The current status of the use of carbon dioxide in diagnostic and interventional angiographic procedures.  Cardiovasc Intervent Radiol. 2006;  29 323-331