RT Journal
A1 Moos JM, Ham SW, Han SM, et al
T1 SAfety of carbon dioxide digital subtraction angiography
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD December 1
VO 146
IS 12
SP 1428
OP 1432
DO 10.1001/archsurg.2011.195
UL http://dx.doi.org/10.1001/archsurg.2011.195
AB Objective 
                  Reports of fatality following carbon dioxide digital subtraction angiography (CO2-DSA) have raised concerns regarding its safety. This study reviews the safety of CO2-DSA.Design 
                  Single-institution retrospective review.Setting 
                  Tertiary care teaching hospital in Los Angeles, California.Patients 
                  A total of 951 patients who underwent 1007 CO2-DSA procedures during a 21-year period.Main Outcome Measures 
                  Preprocedure and postprocedure creatinine values and periprocedural morbidity and mortality.Results 
                  A total of 632 arterial CO2-DSA were performed; 527 were aortograms with or without extremity runoff; 100, extremity alone; and 5, pulmonary. Venous CO2-DSA included 187 inferior vena cavagrams, 182 hepatic or visceral, 5 extremity venograms, and 1 superior vena cavagram. Associated endovascular procedures were performed in 499 cases; 162 were arterial interventions including 62 endovascular aneurysm repairs, 53 visceral or renal percutaneous angioplasty with/without stent, 41 extremity percutaneous angioplasty with or without a stent, and 4 cases of thrombolysis or embolization; 176 caval filters, 98 transjugular intrahepatic portosystemic shunts, 54 transjugular liver biopsies, and 9 other venous interventions. The mean preprocedure creatinine level was 2.1 mg/dL; postprocedure, 2.1 mg/dL (P = .56). There were a total of 61 (6.1%) procedural complications including 4 (0.4%) mortalities. Two were procedure-related complications: 1, suppurative pancreatitis following aortogram; and 2, hepatic bleed following failed transjugular intrahepatic portosystemic shunts. Two were attributable to patient disease; 1, metastatic adenocarcinoma; and 2, refractory, end-stage cardiomyopathy.Conclusion 
                  Carbon dioxide digital subtraction angiography is a versatile technique that can be safely used for diagnostic and therapeutic endovascular procedures. Morbidity and mortality are acceptable with preservation of renal function. Thus, CO2-DSA is a safe alternative to iodinated contrast.