Role of carbon dioxide angiography in management of below knee arterial lesions

Introduction

Many practitioners express concern about the adequacy of imaging using CO₂ in the lower extremities, particularly in the distribution of the popliteal artery and below (5). Published results have varied considerably with respect to the validity of imaging this anatomy.

Objectives

Review our experience with CO₂ angiography using CO₂ angioset in evaluation and intervention of below knee arteries.

Patients and methods

Forty patients with lower limb ischemia were divided into two groups. The 1st group has normal kidney function, subjected to angiography with CO₂ and water soluble contrast media (WSCM) as the reference standard (control). The 2nd group has subjected only to CO₂ angiography due to one or more risk factors related to WSCM. CO₂ angioset is a dedicated CO₂ injection system used in all patients. In the 1st group; imaging findings on CO₂ and WSCM angiography were compared while in the 2nd group; findings were compared with the post procedure clinical and color Doppler findings.

Results

All arterial lesions detected on CO₂ angiography were comparable to those obtained with WSCM in the control group. In the 2nd group; post procedure clinical and Doppler findings correlated well with angiographic findings and angioplasty results. CO₂ angiography images have lower resolution compared to WSCM however, they were reliable for accurate diagnosis and to guide angioplasty.

Conclusion

CO₂ angiography using CO₂ angioset is considered a reliable alternate to WSCM in assessment of below knee arteries and provides a reliable roadmap to interventional procedures.