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.

References

1.     Carelli HH, Sordelli E. A new procedure for examining the kidney. Rev Asoc Med Argent. 1921;34:18-24.

2.     Colle G. Sugli effetti della introduzione di gas in circulo. Arch. Ital. di chir. 1924;9:419-453.

3.     Moor RM, Braselton Jr CW. Injections of air and of carbon dioxide into a pulmonare vein. Annals of Surgery. 1940;112(2):212-218.

https://doi.org/10.1097/00000658-194008000-00004

4.     Hodiev JeM. Contrasting of heart cavities with carbon dioxide. Vestnik rentgenologii i radiologii. 1965;5:8-11 [In Russ].

5.     Hodiev JeM, Mazaev VP. Coronary angiography with carbon dioxide injected into the heart cavity. Jeksperimental'naja hirurgija i anesteziologija. 1967;2:22-25 [In Russ].

6.     Tihonov KB. Possibility and prospects of studying the cardiovascular system using a gas environment. Voprosy rentgenologii i onkologii. 1958;3:61-66 [In Russ].

7.     Antonov OS, Mezencev GD, Blau JuI, Konovalov ED. Carbon dioxide angiocardiography for the diagnosis of congenital and acquired heart defects. Materialy pervoj oblastnoj konferencii rentgenologov i radiologov. 1964;5-8 [In Russ].

8.     Shipovskij VN, Kurbanov RV, Saakjan AM, Marov KB. Carboxyangiography is a new type of contrast enhancement in angiographic practice. First clinical experience. Angiologija i sosudistaja hirurgija. 2010;16:73-82 [In Russ].

9.     Shipovskij VN, Zolkin VN, Kurbanov RV et al. Using carbon dioxide as a contrast agent in aortoarteriography. Vestnik RGMU. 2011;6:16–20 [In Russ].

10.   Derkach VV. Using of an automatic CO₂ injector in patients with critical lower limb ischemia. Angiologija i sosudistaja hirurgija. 2018;24:133-135 [In Russ].

11.   Derkach VV. A case report of superficial femoral artery stenting in a patient with critical limb ischemia and chronic kidney disease under the control of carboxyangiography. Angiologija i sosudistaja hirurgija. 2018;24:133 [In Russ].

12.   Maksimov AV, Makarimov JeSh, Glinkin VV et al. Experience in the use of carbon dioxide in angiography. Prakticheskaja med icina. 2015;1(89):97-100 [In Russ].

13.   Zatevahin II, Kokov LS, Shipovskij VN et al. Diagnostics and endovascular treatment of arterial insufficiency of lower limbs. M.: RAN. 2019;244 [In Russ].

14.   Back MR, Caridi JG, Hawkins IF Jr, Seeger JM. Angiography with carbon dioxide (CO₂). Surgical Clinics of North America. 1998;78(4):575-591.

https://doi.org/10.1016/S0039-6109(05)70335-2

15.   Ehrman KO, Taber TE, Gaylord GM, Brown PB. et al. Comparison of diagnostic accuracy with carbon dioxide versus iodinated contrast material in the imaging of hemodialysis access fistulas. Journal of Vascular and Interventional Radiology. 1994;5(5):771-775.

https://doi.org/10.1016/S1051-0443(94)71599-2

16.   Cronin P, Patel JV, Kessel DO, Robertson I, McPherson SJ. Carbon dioxide angiography: a simple and safe system of delivery. Clinical Radiology. 2005;60(1): 123-125.

https://doi.org/10.1016/j.crad.2004.05.005

17.   Mascoli C, Faggioli G, Gallitto E. et al. Standardization of a Carbon Dioxide Automated System for Endovascular Aortic Aneuryzm Repair. Annals of Vascular Surgery. 2018;51:160-169.

18.   Caridi JG, Cho KJ, Fauria C, Eghbalieh N. Carbon dioxide digital subtraction angiography (CO₂ DSA): a comprehensive user guide for all perators. Vascular Disease Management. 2014;11(10):221-256.

Abstract:

The aim of the study was to assess effectiveness and safety of ioversol (Optiray). The contrast media used for angiography and endovascular interventions in 286 patients with coronary disease, peripheral atherosclerosis, liver and biliary disease, hysteromyoma etal. Optiray provided good visualization in 100% of cases at all vascular territories; it did not cause significant hemodynamic changes and was shown to have low allergenic capacity. As a rule, Optiray also did not affect aminotransferases serum concentrations or renal function, but in 1,4% of patients, in preexisting renal function impairment or known risk factors (diabetes, arterial hypertension) a rise of blood creatinine level was seen.

The results allow the authors to conclude that Optiray (Ioversol) satisfies all the requirements for modern contrast media. 

Reference

1.     Сергеев П.В., Cвиридов Н.К., ШимановскийН.Л. Контрастные средства. М. 1993; 256.

2.     Сергеев П.В., Юдин А.Л., Поляев Ю.А.,Шимановский Н.Л. Разработка контрастно-диагностических средств для внутрисосудистого введения: от первых опытов донаших дней. Вестник рентгенологии и радиологии. 2002; 1: 48-61.

3.     Morris T.W. X-ray contrast media. Wherearewe now and where are we going? Radiology.1993; 188: 11-16.

4.     Floriani I.E., Ciceri M.A., Torri V.A., TinazziA.M., Jahn, H.S., Noseda A.M. ClinicalProfile of Ioversol: A Metaanalysis of 57 Randomized, Double-Blind Clinical Trials. Invest.Radiology. 1996; 31 (8): 479-491.

5.     Schild H.H., Kuhl C.K., Hubner-Steiner U.A., Bohm I.M. Adverse Events after Unenhanced and Monomeric and Dimeric Contrast-enhanced CT: A Prospective Randomized Controlled Trial. Radiology. 2006; 240: 56-64.

6.     Ralston W. The acute and subacute toxicity ofioversol (Optiray) in laboratory animals.Invest. Radiology. 1989; 24 (2): 231-240.

7.     Hosoya T., Yamaguchi K., Akutsu T. et al.Delayed adverse reactions to iodinated contrast media and their risk factors. Radiat. Med.2000; 18: 39-45.

8.     Stacul F., Cova M., Assante M. et al.Comparison between the efficacy of dimericand monomeric non-ionic contrast media(iodixanol vs iopromide) in urography inpatients with mild to moderate renal insufficiency. Brit.J. Radiol. 1998; 71: 918-922.

9.     Enzweiler C.N., Hohn S.A., Lembcke A.E. etal. Contrast enhancement in electron beamtomography of the heart: comprasion of amonomeric and a dimeric iodinated contrast agent in 59 patients. ActaRadiol. 2006; 13: 95-103.

10.   Lassers E.C., Lyon S.G. Reports of contrastmedia reactions: analysis of data from reports to the U.S. Food and Drug Administrations Radiology. 1997; 203: 605-610.

11.   Bettmann M.A., Heeren T., Greenfield A.,Goudey C. Adverse events with radiographiccontrast agents, results of SCVIR Contrast agents Registry. Radiology. 1997; 203: 611- 620.

12.   Carraro M., Malalan F., Antonione R. et al.Effects of a dimeric vs a monomeric nonioniccontrast medium on renal function in patients with mild to moderate renal insufficiency: a double-blind, randomized clinical trial. Eur. Radiol. 1998; 8: 144-147.

13.   Deray G., Bagnis C., Jacquiaud C. et al. Renal effects of low and isoosmolar contrast media on renal hemodynamic in normal and ischemicdog kidney. Invest. Radiology. 1999; 34: 1-4.

14.   Hayami I.S., Ishigooka1 M.G., Suzuki1 Y.T., Mitobe K.I. Comparison of the nephrotoxicity between ioversol and iohexol. International Urology and Nephrology. 1996; 3: 615-619.

15.   Misawa M., Sato Y., Hara M. et al. Use of nonionic contrast medium, iopromide (Proscope 370), in pediatric cardiovascular angiography. Nihon ShoniHoshasen Gakkai Zasshi. 2000; 16: 42-44.

16.   Кармазановский Г.Г. «Старое» неионное рентгеноконтрастное вещество иоверсол -«новый игрок» на российском рынке контрастных средств. Медицинская визуализация. 2007; 2: 135-139.

17.   Корниенко В.Н., Пронин И.И., Такуш С.В., Фадеева Л.М. Новые возможности контрастирования в нейрорадологии. Медицинская визуализация. 2006; 6: 126-133.