CO2 Digital Subtraction Splenoportography with the ?Skinny? Needle: Experimental Study in a Swine Model

Abstract

CO2 splenoportography with the "skinny" needle is a safe and simple method of visualizing the portal vein and its branches. Careful appraisals of the clinical usefulness of the method will be needed in various clinical settings.

Carbon dioxide wedged arterial splenoportography: A new technique—a case report and an experimental study

“…Further animal studies should be conducted to evaluate the safety and efficacy of CO 2 wedged splenoportography in an animal model with splenic vein occlusion by surgical ligation, embolization, or an occlusion balloon. Our previous animal study with CO 2 splenoportography demonstrated that CO 2 in doses of up to 60 cm 3 could be injected into the spleen without splenic injuries (15).…”

“…The advent of indirect portography (high-dose superior mesenteric, celiac, or splenic angiography) has replaced traditional splenoportography with the injection of contrast medium into the splenic pulp (14). Recently, splenoportography was found to be safer when CO 2 was injected via a ''skinny'' needle (15,16). Although more clinical experience is needed, we feel that wedged arterial splenoportography with CO 2 is theoretically equally effective in depicting the splenic vein while having the advantage of being less invasive and less traumatic to the spleen.…”

Carbon Dioxide Angiography: Scientific Principles and Practice

“…In 1970s, because of the risk of bleeding associated with splenoportography using a larger needle and contrast medium, the procedure has been largely replaced by noninvasive imaging method and arterial portography (indirect portography). CO 2 transsplenic portography using a 22 to 25 gauge needle is a safe and effective technique for visualizing the portal venous system and portosystemic collaterals [ 30 , 31 ]. CO 2 splenoportography is useful, especially in pediatric patients when an imaging study of portal vein is inconclusive.…”

“…This may cause diarrhea and even colonic ischemia. Another potential vapor lock may develop when CO 2 angiography is performed during nitrous oxide anesthesia in which less soluble nitrogen can diffuse into the trapped CO 2 bubble resulting in expansion of the bubble containing less soluble nitrogen [ 30 ].…”