Venography with carbon dioxide as a contrast agent

Purpose The purpose of this study was to evaluate the feasibility, safety, and potential role of carbon dioxide (CO₂) as a contrast agent for venography.Methods Consecutive patients with contraindications to iodinated contrast agents or with unsatisfactory iodinated contrast studies underwent CO₂ digital subtraction venography. The images were rated by three experienced angiographers. Image quality and complications were assessed.Results Over a 14-month period, 66 vein segments were studied in 21 patients. There was good correlation between experienced angiographers on CO₂ image quality (R_i = 0.80) and good agreement on diagnosis (k = 0.62). In 91% of the vein segments evaluated with CO₂ there was interobserver agreement on the diagnosis. Upper extremity veins were adequately imaged with CO₂ alone in all (6/6) patients with contraindications to iodinated contrast. Following suboptimal iodinated contrast studies in six patients, CO₂ produced significantly better quality upper extremity central vein images (p < 0.05). Pain following injection into peripheral veins was the only CO₂-related complication. Inferior vena cava (IVC) filters were successfully deployed with CO₂ alone in 78% (7/9) of patients; two required iodinated contrast.Conclusion Based upon initial experience, CO₂ venography can be recommended in patients with contraindications to iodinated contrast or unsatisfactory iodinated contrast studies.Presented before the Annual Meeting and Postgraduate Course, Cardiovascular and Interventional Radiological Society of Europe, June 7, 1994, Aghia Pelaghia, Crete, Greece.