Mechanical aspects of CO2 angiography

Corazza, Ivan; Rossi, Pier Luca; Feliciani, Giacomo; Pisani, Luca; Zannoli, S.; Zannoli, Romano

doi:10.1016/j.ejmp.2011.11.003

Cited by 15 publications

(5 citation statements)

References 24 publications

(12 reference statements)

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“…Preferred method is via automated injectors (automated CO 2 mmanders). Hand held syringes have been used in the past but are not commonly used now due to increased risk of complications such as air contamination and explosive over dosage[5,6]. …”

Section: Introductionmentioning

confidence: 99%

Use of carbon dioxide as an intravascular contrast agent: A review of current literature

Ali¹,

Mangi²,

Rehman³

et al. 2017

WJC

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Use of X-ray contrast allows us to differentiate between two or more adjacent structures on radiographic studies. The X-ray contrast agent can be the one with increase X-ray absorption, like iodine and a barium X-ray contrast agent or the one with decrease X-ray absorption like air and carbon dioxide contrast agent. Each contrast agent possesses different risks and benefits in various ways. Carbon dioxide as an intravascular contrast agent can be used as an alternative intravascular contrast agent and has superior results in some cases. In patients with renal dysfunction or iodinated contrast allergy, the use of Iodinated Contrast Agent poses the risk of considerable morbidity. Similarly, use of Gadolinium is discouraged in subject with severe renal dysfunction. Use of carbon dioxide (CO2) as an intravascular contrast, offers an alternative in such patients for certain procedures, as it is not nephrotoxic and it does not incite allergic reactions. It is inexpensive, readily available and due to its unique physical properties, it can be used to image a wide variety of vascular beds and chambers. The aim of this paper is to systemically review the current literature to describe the indications, contraindications, adverse effects, instruments, precautions, latest methodologies and data supporting for the use of CO2 as a contrast agent.

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Section: Introductionmentioning

confidence: 99%

Use of carbon dioxide as an intravascular contrast agent: A review of current literature

Ali¹,

Mangi²,

Rehman³

et al. 2017

WJC

View full text Add to dashboard Cite

show abstract

“…3 are shown in Figs. 4 and 5a/b/c. The relationship between intravascular pressure and the CO /iodine contrast medium ratio of the equivalent circle diameter as well as that of intravascular pressure and the CO /iodine contrast medium ratio of the equivalent circle area is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Owing to its low viscosity, CO is sensitive enough to detect extravasation, and CO angiography is thought to be effective in identifying the source of bleeding, even when the source of bleeding cannot be determined by angiography with iodine contrast medium [2]. However, basic studies on CO angiography are rare and few have examined iodine contrast medium and CO in detail [4]. In this study, a bleeding model was created using a vascular model to compare the hydrodynamics of CO and iodine contrast mediumum to understand the effect of CO in increasing the sensitivity of bleeding detection.…”

Section: Introductionmentioning

confidence: 99%

In vitro comparison of the leakage of carbon dioxide and iodine contrast medium in a bleeding model

Kitamura,

Yoshida,

Maruhashi

et al. 2024

Preprint

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Purpose This study aimed to evaluate the effect of carbon dioxide (CO₂) on the sensitivity of bleeding detection by comparing the hydrodynamics of CO₂ and iodine contrast medium using a bleeding model. Materials and methods We created a bleeding model with large and small wounds in simulated blood vessels. A syringe was connected to the bleeding model and a blood pressure transducer, and the circuit was filled with CO₂ and iodine contrast medium. The piston of the syringe was pressed, and then the flow rate and intravascular pressure of the CO₂ and iodine contrast medium leaking from the bleeding model were measured. The volume, sphere-equivalent diameter, and sphere-equivalent area of the leaked contrast medium were compared. Results At a constant flow rate, the intravascular pressure required for the model to leak was lower for the CO₂ than for the iodine contrast medium, and it was also lower for larger wounds. The CO₂ contrast medium leakage volume, equivalent circle diameter, and equivalent circle area were greater than those of the iodine contrast medium, and they were also greater for larger wounds. Conclusions In the bleeding model, the CO₂ contrast medium may be more prone to leakage than the iodine contrast medium in large and small wounds. In terms of visibility, the CO₂ contrast medium may be more likely to detect leakages than the iodine contrast medium.

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“…CO 2 has relatively low viscosity (1/400 of contrast media); therefore, the gas passes well through the collaterals and improves detection of acute haemorrhages. 8 The administration through microcatheters is easier. CO 2 can be administered around the wire in catheters using a Y-connector without losing wire position, and it is not diluted by blood like liquid contrast media.…”

mentioning

confidence: 99%

“…CO 2 can be administered around the wire in catheters using a Y-connector without losing wire position, and it is not diluted by blood like liquid contrast media. 8 A further advantage is that CO 2 excretes through the lung in 1 to 3 minutes; therefore, theoretically unlimited amount could be used as opposed to the nephrotoxic ICM.…”

mentioning

confidence: 99%

Digital Variance Angiography as a Paradigm Shift in Carbon Dioxide Angiography

et al. 2019

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Objectives: Our aim was to investigate the feasibility of digital variance angiography (DVA) in lower extremity CO 2 angiography and to compare the quantitative and qualitative performance of the new image processing technique with that of the current reference standard digital subtraction angiography (DSA). Materials and Methods: This prospective study enrolled 24 patients (mean age ± SD, 65.5 ± 9.2 years; 14 males, 65.1 ± 7.5 years; 10 females, 66.1 ± 11.6 years) undergoing lower-limb CO 2 angiography between December 2017 and April 2018 at 2 clinical centers: The Heart and Vascular Center (HVC) of Semmelweis University, Budapest (7 patients), and the Bács-Kiskun County Hospital (BKCH) in Kecskemét (17 patients). The interventional protocol was similar at both sites, but the image acquisition instruments and protocols were different, which allowed us to investigate DVA in different settings. For comparison, the signalto-noise ratio (SNR) of DSA and DVA images were calculated. The visual quality of DSA and DVA images were compared by independent clinical specialists using an online questionnaire. Interrater agreement was characterized by percent agreement and Fleiss kappa. The specialists also evaluated in a random and blinded manner the individual DSA and DVA images on a 5-grade scale ranging from poor (1) to outstanding (5) image quality, and the mean ± standard error of mean (SEM) was calculated. Results: A total of 4912 regions of interest were carefully selected in 110 image pairs to determine the SNRs. The ratio of SNR DVA /SNR DSA was calculated. At HVC, it ranged between 2.58 and 4.16 in the anatomical regions (abdominal, iliac, femoral, popliteal, crural, talar), and the overall median value was 3.53, whereas at BKCH the range was 2.71 to 4.92 and the overall median value was 4.52. During the visual evaluation, 120 DSA and DVA image pairs were compared. At HVC in 78%, although at BKCH in 90% of comparisons, it was judged that DVA provided higher quality images. The interrater agreement was 88% (P < 0.001) and 90% (P < 0.01), respectively. DVA images received consistently higher individual rating than DSA images, regardless of the research site and anatomical region. At HVC, the overall DSA and DVA scores (mean ± SEM) were 2.75 ± 0.12 and 3.23 ± 0.16, respectively (P < 0.05), whereas at BKCH these values were 2.49 ± 0.10 and 3.03 ± 0.09, respectively (P < 0.001). Conclusions: These data show that lower-limb CO 2 angiography DVA, regardless of the image acquisition instruments and protocols, produces higher SNR and significantly better image quality than DSA; therefore this new image processing technique might help the widespread use of CO 2 as a safer contrast agent in clinical practice.

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Mechanical aspects of CO2 angiography

Cited by 15 publications

References 24 publications

Use of carbon dioxide as an intravascular contrast agent: A review of current literature

Use of carbon dioxide as an intravascular contrast agent: A review of current literature

In vitro comparison of the leakage of carbon dioxide and iodine contrast medium in a bleeding model

Digital Variance Angiography as a Paradigm Shift in Carbon Dioxide Angiography

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