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.