Carbon dioxide as a contrast agent to guide vascular interventional procedures.

Eschelman, David J.; Sullivan, Kevin L.; Bonn, Joseph; Gardiner, G A

doi:10.2214/ajr.171.5.9798858

Cited by 32 publications

(11 citation statements)

References 29 publications

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“…Furthermore, carbon dioxide has been used as a negative contrast agent safely for many years during peritoneal and pericardial imaging and has been applied as a contrast agent for arteriography and venography since 1971 [32]. Thus, radiologic-guided percutaneous foam injection should be feasible because the foam sclerosant, which consisted chiefly of gas, was regarded as a negative contrast agent.…”

Section: Discussionmentioning

confidence: 99%

Digital Subtraction Angiography–Guided Foam Sclerotherapy of Peripheral Venous Malformations

Zeng

2010

American Journal of Roentgenology

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W439As a result of the development of sclerosants in foam form, sclerotherapy has entered a new era [1][2][3]. Foam sclerosants have several advantages over conventional liquid sclerosants [1][2][3]. First, it is easy to manipulate and control the sclerosing action. The foam sclerosant displaces the blood, instead of mixing with it, and occupies the interior of the vessel completely, which makes it a manageable sclerosant that produces predictable results. Second, foam sclerosants have very limited or no toxicity [1-3]. The presence of very small microbubbles increases the contact area between the sclerosant and the walls of the vessel, which results in a more homogeneous dosage and better results. This increased contact area means that the amount of sclerosant required is much lower than with conventional liquid sclerosants and, therefore, never reaches toxic levels [1-3]. Thus, a lower concentration of foam sclerosants gives a similar or better effect than liquid sclerosants. Third, foam sclerotherapy is pain free [1-3] and easy to repeat. The discomfort experienced is about the same as that experienced during the taking of a Va s c u l a r a n d I nt e r ve nt io n a l R a d io l og y • O r ig i n a l R e s e a rc h WEB This is a Web exclusive article.

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Section: Discussionmentioning

confidence: 99%

Digital Subtraction Angiography–Guided Foam Sclerotherapy of Peripheral Venous Malformations

Zeng

2010

American Journal of Roentgenology

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“…Due to the mechanism of CO 2 imaging (displacement of blood), intra‐arterial imaging has been associated with significant although transient neurological symptoms; however, this patient did not have a residual shunt and the CO 2 was used safely in the venous system to image the SVC . Use of CO 2 during percutaneous vascular interventions has been described and, when used along with conventional media, is associated with significantly less radiocontrast use …”

Section: Discussionmentioning

confidence: 96%

“…11 Use of CO 2 during percutaneous vascular interventions has been described and, when used along with conventional media, is associated with significantly less radiocontrast use. [12][13][14] We employed TEE as adjunct imaging to confirm the area of stenosis, pulmonary venous return, and to confirm balloon and stent location. The mid-esophagus bicaval view (approximately 100 degrees) was employed for orientation and fine-tuning of the two-dimensional images.…”

Section: Discussionmentioning

confidence: 99%

Superior Vena Cava Stenting Guided by Alternative Imaging Modalities in a Patient with Severe Contrast Allergy: A Case Report and Brief Literature Review

Pillutla

Reardon

Aboulhosn³

2013

Congenit Heart Dis

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Major adverse reactions to iodinated radiocontrast media are an uncommon but serious complication of cardiac catheterizations. We present a case of a 52-year-old woman with a sinus venosus atrial septal defect and partial anomalous pulmonary venous connection status post repair who presented with superior vena cava graft obstruction. Two overlapping stents were placed within the superior vena cava using gadolinium, CO2 angiography and transesophageal echocardiography for visualization of the graft stenoses. No iodinated media were used.

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“…CO 2 is quite distinctive from other contrast agents that depend mostly on T1 shortening caused by a paramagnetic agent. As CO 2 is a normal blood component, the human organism is equipped to completely clear large quantities of it during its first pass through the lungs (15–17). Any signal changes caused by residual contrast, such as after injection of gadolinium‐DTPA, are thereby avoided.…”

Section: Discussionmentioning

confidence: 99%

Combined use of the intravascular blood‐pool agent, gadomer, and carbon dioxide: A novel type of double‐contrast magnetic resonance angiography (MRA)

Maes¹,

Lewin

Duerk

et al. 2005

Magnetic Resonance Imaging

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Purpose:To evaluate the combined use of carbon dioxide (CO 2 ) and a gadolinium-based blood-pool agent for magnetic resonance angiography (MRA). Materials and Methods:After an initial intravenous injection of the blood-pool agent Gadomer (Schering AG, Germany), repeated transcatheter CO 2 injections were performed in the aorta and the renal arteries of two fully-anesthetized pigs. Real-time images were acquired using a true fast imaging with steady-state precession (FISP) sequence.Results: During the CO 2 injections, the Gadomer-enhanced blood was totally replaced, resulting in an immediate, temporary, total signal loss in the vessel lumen. Susceptibility artifacts during the injections or catheter manipulations rarely occurred. Conclusion:Due to T1-shortening, the circulating bloodpool agent prevents flow artifacts during catheter manipulations because the steady-state is reached much earlier. Therefore, this double-contrast MRA method improves catheter conspicuity and might be helpful for guiding and controlling intravascular procedures during interventional MRI. ACCURATE VISUALIZATION of target vessels and continuous confirmation of vessel patency is essential during intravascular interventions.Most non-contrast-enhanced MR angiography (MRA) sequences, such as time-of-flight and phase-contrast angiography, have limitations when used for guidance of vascular interventions due to their acquisition times of longer than one second. Contrast-enhanced angiography techniques are much faster but require repeated injections due to their very short intravascular retention time. Because large quantities of gadolinium-based contrast agents increase the background signal intensity over the course of the procedure, alternatives are needed.One solution is the use of a real-time bright-blood MR steady-state free precession (SSFP) sequence such as true fast imaging with steady-state precession (true FISP) (1). In addition to the excellent vessel conspicuity, true FISP imaging offers exceptionally high signal with a short repetition time, thus making it an ideal imaging method to guide interventional procedures (2). However, in order to assess blood flow distal to an interventional device such as a catheter or stent, the use of a dark blood agent, like gaseous CO 2 , would be advantageous (3,4). In order to prevent distorting artifacts during catheter manipulation during the SSFP sequences, as suggested by other researchers, we injected a bloodpool agent (5). The T1-shortening caused by the circulating blood-pool agent is known to prevent flow artifacts because the steady state is reached much earlier.The aim of our study is to test the feasibility of the combined use of CO 2 and an intravascular blood-pool agent (Gadomer; Schering AG, Berlin, Germany) for MRA and to discuss its potential use in interventional MRI.

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Carbon dioxide as a contrast agent to guide vascular interventional procedures.

Cited by 32 publications

References 29 publications

Digital Subtraction Angiography–Guided Foam Sclerotherapy of Peripheral Venous Malformations

Digital Subtraction Angiography–Guided Foam Sclerotherapy of Peripheral Venous Malformations

Superior Vena Cava Stenting Guided by Alternative Imaging Modalities in a Patient with Severe Contrast Allergy: A Case Report and Brief Literature Review

Combined use of the intravascular blood‐pool agent, gadomer, and carbon dioxide: A novel type of double‐contrast magnetic resonance angiography (MRA)

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