Use of Carbon Dioxide as a Contrast Medium for Transjugular Intrahepatic Portosystemic Shunt Procedures

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

“…The use of CO2 as a contrastagent has been described for venacavographybefore filter placement [16,24] and for fluoroscopic guidance dur ing placement of peripherally inserted cen tral catheters [25,26]. Rees et al [27] have performed three TIPS procedures using only CO2. and severalauthorsdescribeangiogra phy using CO2 to guide angioplasties of the renal, iliac, or femoropopliteal arteries [ and a transient increase in serum creatinine level was found in only two patients, who had received 60 and 70 ml of iodinated con trast material, respectively.…”

Carbon Dioxide in Vascular Imaging and Intervention

“…Injection of C 0 2 in C02-DSA can be performed either manually or automatically. For manual injection, 35 or 60 cm3 plastic syringes are filled from a medical grade C 0 2 gas tank after flushing with C 0 2 4 to 6 times and then attached to the catheter (15, 26,31,33,39,41). A standard mechanical injector can be also used for C 0 2 angiography, with two 3-way stopcocks which allow a closed system of C 0 2 delivery (6).…”

“…When using a manual injector, C 0 2 gas should be rapidly injected with total volume of 15 to 75 cc of C 0 2 gas, at 15 to 35 cc/s flows for the aorta and larger arteries and at 12 to 16 cc/s flows for selective injections (15,26,39,43). In TIPS procedures, very rapid, nearly instantaneous injection of a relative large volume of C 0 2 gas is necessary to yield good image quality (31). For i.v.…”

“…Other authors have found that C 0 2 gas facilitates the accurate stent placement during TIPS procedures by providing better visualization than that obtained with liquid media (31). The explanation may be that the C02 gas could be rapidly forced through the tiny side port of the Wallstent delivery system (31). C 0 2 gas may also have a role as a contrast medium in the imaging of atherectomy procedure (43).…”

CO2 wedged hepatic venography: technical considerations and comparison with direct and indirect portography with iodinated contrast

“…Several techniques are available for imaging the portal system: computed tomography (CT), magnetic resonance (MR), MR angiography (MRA), color Doppler ultrasound (US), and indirect (IP) and direct (DP) portography [2]. Rees et al reported good to excellent results in 10 of 12 patients using carbon dioxide (CO 2 ) as a contrast agent for wedged hepatic venography, which allowed them to determine portal venous patency and to plan the intended tract for performing a TIPS [3]. Other investigators also have reported good results [4 -7].…”