Abstract:

Introduction: carboxyangiography does not come into extensive use nowadays, due to two fundamental reasons: the impossibility of getting an equitable to Iodinated Contrast Agents (ICA) quality of angiographic image without special angiography system software. Besides, labour intensity, continuance, and potential risks of the methodology of «hand-operated» injection of carbon dioxide. Carboxyangiography made by automatic injector CO₂ appears a fundamentally new technique, free from pointed limitations.

Aim: was to inform possibilities and safety of carboxyangiography with automatic injector in different vascular basins.

Materials and methods: article presents data on possibilities and safety of performing carboxyangiography of various vascular basins, based on the analysis of world literature data. Data on indications and contraindications, on  features of this technique are presented. Article also provides clinical examples of such interventions as: revascularization of various peripheral basins (renal arteries, arteries of lower limbs, veins of upper limbs), primary and secondary interventions for abdominal aortic aneurysms (EVAR, diagnostics of endoleaks), formation and disconnection of various fistulas and shunts (TIPS, correction of fistulas and AVMs), interventions for gastrointestinal bleedings, implantation of cava filters, as well as a number of diagnostic procedures.

Conclusions: carboxyangiography with the use of the automatic injector can be performed for diagnostic and treatment endovascular interventions, as well in high operation risk patients with contrast-induced nephropathy (CIN) or/and ICA allergy. In case of use of automatic injector and special angiographic software, image quality is highly competitive with ICA contrast-enhanced imaging.

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Abstract:

Background and aim: in Russian Federation, more than 10 million people suffer from peripheral artery disease (PAD), and from chronic limb-threatening ischemia (CLTI) as one of it’s complications. According to Russian guidelines on treatment of patients with CLTI, the initial diagnosis should include measurement of ankle-brachial and finger-brachial indices (ABI, ТВ I), as well as ultrasound duplex scanning (USDS) - however, the sensitivity and diagnostic accuracy of these methods are often insufficient. In this review, we have summarized the entire range of modern instrumental methods for early and effective diagnosis of critical lower limb-threatening ischemia and for the evaluation of limb perfusion.

Materials and methods: 31 sources of domestic and foreign literature published in last 5 years on the issue of modern possibilities for early precision diagnosis of critical limb-threatening ischemia were examined.

Results and conclusions: AHA Experts recommend some experimental technologies for evaluating lower limb perfusion, including angiography with indigocarmine, perfusion computed tomography (CT perfusion), magnetic resonance imaging (MRI), contrast echography, and hyperspectral imaging. Among other things, implantable bio-sensors can be identified: for example, oxygen-platform LuMee, which works in real time and provides continuous monitoring of oxygen levels in tissues. New technologies allow us to improve the accuracy of diagnosis and quality of treatment of patients with CLTI. It is worth considering switching from traditional methods to more modern ones, which can significantly reduce the frequency of amputations and the risk of disability and improve the quality of life of our patients.

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