REGULAR CONTENT
Final ID
609
Type
Educational Exhibit-Poster Only
Authors
M Chill1, A Salem2, E Kurz1, D Cummings1, W Kwon3
Institutions
1SUNY Downstate Medical Center, Brooklyn, NY, 2SUNY Downstate, Brooklyn, NY, 3N/A, New York, NY
Purpose
1. Identify scenarios in which carbon dioxide (CO2) should be utilized as a contrast agent for angiography.2. Review of basic physiology of intravascular CO2 and how we can utilize it to our advantage. 3. Recognize and manage possible complications associated with intravascular CO2 administration.
Materials & Methods
CO2 has been utilized as a contrast agent since the 1950s. With the recent advent of smaller and more user-friendly devices, it has become increasingly practical to use CO2 in clinical practice.There are a variety of situations in which it is favorable to use CO2 as a contrast agent, including in the setting of a contrast allergy, renal failure not on dialysis and for visualization of the portal venous system. With an understanding of the physiology of intravascular CO2 and imaging physics, one is able to generate clinically useful fluoroscopic images. Though complications related to CO2 angiography are rare, it is important to recognize and know how to treat them.
Results
Following a review of the pertinent physiology, proper indications and usage of CO2 angiography, we present two case examples:1. 94 year old male with a dialysis fistula, presents with low flow during dialysis. His history is complicated by a severe contrast allergy which once resulted in anaphylaxis. A fistulogram is performed utilizing CO2 as a contrast agent. Regions of stenosis are identified in the outflow vein and are treated with balloon angioplasty. Post treatment images demonstrate an improved appearance. 2. 67 year old female with a history of renal failure not on dialysis presents for an IVC filter following surgery with expected prolonged immobilization. CO2 was selected as a contrast agent on account of the patient's poor renal function. A cavogram is performed demonstrating the location of the renal veins and an IVC filter is deployed.
Conclusions
CO2 is an excellent alternative when traditional contrast media is contraindicated. It is relatively safe and easy to use. One can utilize a basic understanding of its physiology in order to generate excellent images. It is prudent to recognize the rare but potentially life threatening complications and know how to respond instantly.
Final ID
609
Type
Educational Exhibit-Poster Only
Authors
M Chill1, A Salem2, E Kurz1, D Cummings1, W Kwon3
Institutions
1SUNY Downstate Medical Center, Brooklyn, NY, 2SUNY Downstate, Brooklyn, NY, 3N/A, New York, NY
Purpose
1. Identify scenarios in which carbon dioxide (CO2) should be utilized as a contrast agent for angiography.2. Review of basic physiology of intravascular CO2 and how we can utilize it to our advantage. 3. Recognize and manage possible complications associated with intravascular CO2 administration.
Materials & Methods
CO2 has been utilized as a contrast agent since the 1950s. With the recent advent of smaller and more user-friendly devices, it has become increasingly practical to use CO2 in clinical practice.There are a variety of situations in which it is favorable to use CO2 as a contrast agent, including in the setting of a contrast allergy, renal failure not on dialysis and for visualization of the portal venous system. With an understanding of the physiology of intravascular CO2 and imaging physics, one is able to generate clinically useful fluoroscopic images. Though complications related to CO2 angiography are rare, it is important to recognize and know how to treat them.
Results
Following a review of the pertinent physiology, proper indications and usage of CO2 angiography, we present two case examples:1. 94 year old male with a dialysis fistula, presents with low flow during dialysis. His history is complicated by a severe contrast allergy which once resulted in anaphylaxis. A fistulogram is performed utilizing CO2 as a contrast agent. Regions of stenosis are identified in the outflow vein and are treated with balloon angioplasty. Post treatment images demonstrate an improved appearance. 2. 67 year old female with a history of renal failure not on dialysis presents for an IVC filter following surgery with expected prolonged immobilization. CO2 was selected as a contrast agent on account of the patient's poor renal function. A cavogram is performed demonstrating the location of the renal veins and an IVC filter is deployed.
Conclusions
CO2 is an excellent alternative when traditional contrast media is contraindicated. It is relatively safe and easy to use. One can utilize a basic understanding of its physiology in order to generate excellent images. It is prudent to recognize the rare but potentially life threatening complications and know how to respond instantly.