Vascular Imaging with Carbon Dioxide: Confidence in a Safe, Efficacious, User-Friendly System

Abstract

Carbon dioxide (CO₂) has been used as an imaging agent since the early 1900s. The intravascular use of CO₂ for imaging began in the 1960s. Its use was limited, as the available technology for imaging and safe delivery was poor. Even until today its use as an imaging agent has not reached its potential because of non–user friendly and cumbersome delivery methods. Confusing tanks, valves, and assembly of do-it-yourself systems create an aversion to its use. As an invisible agent with properties vastly different from liquid contrast, well-seasoned interventionalists are hesitant to use it because of perceived often unrealistic potential complications. Despite many of the advantages of a gaseous imaging agent, insecurity has translated to its lack of use and availability to the benefit of patients. With the development of the new CO₂mmander/AngiAssist delivery system (AngioAdvancements, Inc; Ft. Meyers, FL), a compact, unwieldy, easily understood, closed system that does not require assembly is replacing the various makeshift systems in the CO₂ community. This system combines a small multiuse disposable cylinder, compact regulator, and a dual syringe delivery system to the patient. A unique proprietary valve (K-valve) prevents the possibility of CO₂ overload during delivery. Because of one-way valves and the prepackaged complete setup, operator error and air contamination with inadvertent connections are eliminated. Noncompressed CO₂ is administered in the volume of choice in a nonexplosive manner. This simple, yet safe and effective, delivery system will undoubtedly promote the greater use of intravascular CO₂. This in turn will translate into improved patient care in both the diagnostic and interventional arena.

Keywords

contrast - vascular imaging - CO₂ - carbon dioxide - interventional radiology

• References

• 1 Rotenberg E. Rontgenophotographie der leber, der Milz, und des Zwerchfells. Dtsch Med Wochenschr 1914; 40: 1205
• 2 Rosenstein P. Pneumoradiology of kidney position-a new technique for the radiological representation of the kidneys and neighboring organs (suprarenal gland, spleen, liver). J Urol 1921; 15: 447
• 3 Carlli HH. A new procedure for examining the kidney. Rev Asoc Med Argent 1921; 34: 18-24
• 4 Scatliff JH, Kummer AJ, Janzen AH. The diagnosis of pericardial effusion with intracardiac carbon dioxide. Radiology 1959; 73: 871-883
• 5 Paul RE, Durant TM, Oppenheimer MJ, Stauffer HM. Intravenous carbon dioxide for intracardiac gas contrast in the roentgen diagnosis of pericardial effusion and thickening. Am J Roentgenol Radium Ther Nucl Med 1957; 78 (2) 224-225
• 6 Hawkins IF. Carbon dioxide digital subtraction arteriography. AJR Am J Roentgenol 1982; 139 (1) 19-24
• 7 Hawkins IF, Caridi JG. Carbon dioxide (CO2) digital subtraction angiography: 26-year experience at the University of Florida. Eur Radiol 1998; 8 (3) 391-402
• 8 Caridi J, Cho K, Furia C , et al. Carbon dioxide digital subtraction angiography (CO2 DSA): a comprehensive user guide for all operators. Vasc Dis Manag 2014; 11 (10) E221-E256
• 9 Hawkins Jr IF, Caridi JG, Kerns SR. Plastic bag delivery system for hand injection of carbon dioxide. AJR Am J Roentgenol 1995; 165 (6) 1487-1489