Carbon dioxide a safe, effective contrast alternative for vascular procedures
Carbon dioxide could be used as a safe and effective alternative contrast option during vascular procedures.
New data published in European Radiology recently detailed the utility of the colorless, odorless gas as a contrast agent. Researchers believe that it could be especially beneficial in patients with impaired kidney function.
“The potential of carbon dioxide (CO2) as a negative contrast agent was recognized several decades ago. Subsequently, based on availability, low cost, no obvious toxicity or allergies, and rapid tissue clearance, the agent was considered a natural choice as a negative contrast agent in a variety of nonvascular imaging applications such as cisternography, peritoneography, or double-contrast gastrointestinal imaging,” Andreas H. Mahnken, MD, with the department of diagnostic and interventional radiology at Public University of Marburg, in Germany, and colleagues explained. “The safety of CO2 over other gases is attributed to its much higher tissue solubility, minimizing the risk of serious complications from inadvertent gas embolism.”
Less is known about using the gas in vascular applications. To address this, researched recently pooled data from 11 studies on the use of CO2 as a contrast alternative. Focusing on the safety profile specifically, the team evaluated the agent’s use in multiple interventional procedures.
In doing so, the group determined CO2 to be both safe and effective for a myriad of vascular procedures. It was especially beneficial for patients at risk of contrast-associated acute kidney injury (CA-AKI). Overall, fewer instances of minor, non-serious events were recorded when using CO2 in comparison to ICM. The group noted that it is particularly beneficial in IR procedures that target peripheral artery disease (PAD). No critical dose was established in the meta-analysis, but the studies provided ample information relative to safety thresholds, the group noted.
Of note, the group acknowledged that certain comorbidities increased the risk of kidney injury when using CO2 for angiography purposes.
“There was a high residual risk of CA-AKI in endovascular aneurysm repair (EVAR) and lower limb PAD procedures using CO2 angiography, indicating other contributing factors to CA-AKI, such as hypertension, heart failure, coronary artery disease, diabetes or microembolic renal events during the cannulation of the renal arteries in branched, chimney or fenestrated EVAR procedures,” the authors explained, later adding that “... the risk of a functional decline appears to be more complex than the simple question of the contrast used.”
Overall, the team suggested that CO2 is a safe substitute that can reduce the need for ICM, though more research is needed on its use in EVAR procedures.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.