Carbon Dioxide Angiography: Principles, Techniques, and Practices [ Active ]

Preface

The main objective of writing this book was to present to radiologists and other physicians and health care providers the necessary information for the safe, effective performance of carbon dioxide angiography. With the use of carbon dioxide images and diagrams, it provides a practical approach to the use of carbon dioxide as a contrast agent for diagnostic angiography, vascular intervention, and other nonvascular interventional procedures. Outlining the rationale for the use of carbon dioxide, technical details, and clinical applications, this book should be a necessary reference for physicians performing diagnostic angiography and vascular intervention. Recognized as the only safe contrast agent, carbon dioxide is used routinely as a contrast agent in all regions of the body, except for the brain, heart, and thoracic aorta.

Since its first use as an intravenous contrast medium in the 1950s, carbon dioxide has been used worldwide as a contrast agent for numerous vascular and nonvascular procedures in various organs and arterial circulation below the diaphragm, as well as in the venous circulation. The use of carbon dioxide in vascular interventions ranges from localization of gastrointestinal and traumatic bleeding, transcatheter tumor embolization, and vascular stenting to venous interventions, in addition to wedged hepatic and splenoportography.

Neither nonionic iodinated contrast medium nor gadolinium-based contrast medium is safe; these contrast mediums may cause allergic reactions or nephrotoxicity. In recent years, 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 expansion in its clinical applications, including the use of carbon dioxide during peripheral vascular stenting and abdominal aortic stent graft placement.

With the use of high-resolution digital subtraction technique, stacking, carbon dioxide software, and reliable gas delivery with the plastic bag system, carbon dioxide imaging is quite comparable to the standard contrast angiography. Because of the unique physical properties (including low viscosity, high solubility, and the lack of nephrotoxicity), carbon dioxide is preferable in many diagnostic angiography and vascular interventional procedures that often require large amounts of contrast medium. There is no limit to the amount of carbon dioxide that can be used in the vascular system. Provided that gas delivery is separated by two to three minutes, unlimited volumes of the gas can be injected into the arterial or venous circulation. The volumes of the gas necessary for vascular imaging, which is usually less than 50 cc, is well tolerated without any vital sign changes. Carbon dioxide is inexpensive, easily available, and has no allergic reaction or renal toxicity.

This book outlines a practical approach to the use of carbon dioxide as a contrast agent in a variety of diagnostic and interventional vascular procedures. Included are the authors' expertise and images collected from more than 25 years of clinical experience, laboratory research data, and strategies developed by the authors in the application of carbon dioxide angiography. Because of the difference in properties of carbon dioxide and iodinated contrast medium, we have illustrated abundantly to highlight critical technical information and the angiographic appearance of various diseases with carbon dioxide while continuing to emphasize the advantages and disadvantages of carbon dioxide. The approaches and techniques we describe are personal and reflect the angiographic approaches and techniques that we have found most practical and useful. There are many repetitions on techniques, approaches, and equipment throughout the book that will help beginning users to understand the gas as a contrast agent and make them comfortable with carbon dioxide in various vessels and organs.

The contents of this book are organized into six parts to describe the evolution of carbon dioxide as a contrast agent, the physics and gas dynamics, recent clinical and animal studies on the safety and tolerance of carbon dioxide as a venous contrast agent, and monitoring methods during carbon dioxide angiography. This expansive reference provides the principles, techniques, advantages, and disadvantages of carbon dioxide in all regions of the vascular system, including the abdominal aorta and runoff vessels, splanchnic and renal arteries, renal transplant, tumors, and traumatic and gastrointestinal bleeding. In addition, it details the use of carbon dioxide in the evaluation of aneurysm, vascular malformations, angioplasty, embolization, stent placement, and thrombolysis. The chapters for the venous circulation detail the utilization of carbon dioxide in inferior vena cavography prior to filter insertion, wedged hepatic venography, splenoportography, transjugular intrahepatic portosystemic shunt procedures using large or fine needle, and various venous interventions. This book also covers the use of carbon dioxide for percutaneous nephrostomies using the blunt needle and the plastic bag system for carbon dioxide delivery, and discusses strategies for preventing complications.

Familiarity with the physical properties of carbon dioxide, avoidance of air contamination, catheterization techniques, radiation safety, vascular anatomy, and physiologic monitoring is essential for the safe and effective performance of carbon dioxide angiography. It should be noted that the indications and usage of carbon dioxide in this book are not only used by the authors' institutions, but are also recommended in the medical literature.

The editors wish to express their thanks to the faculty members of the Section of Interventional Radiology at the University of Michigan and the University of Florida, and to the publishers for their consideration and helpful guidance.