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Safety of carbon dioxide digital subtraction angiography.
MedLine Citation:
PMID:  22288088     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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.
Authors:
John M Moos; Sung W Ham; Sukgu M Han; Wesley K Lew; Hong T Hua; Douglas B Hood; Vincent L Rowe; Fred A Weaver
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  146     ISSN:  1538-3644     ISO Abbreviation:  Arch Surg     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2012-01-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1428-32     Citation Subset:  AIM; IM    
Affiliation:
Division of Vascular Surgery and Endovascular Therapy, CardioVascular Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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