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Bürckenmeyer F, Schmidt A, Diamantis I, Lehmann T, Malouhi A, Franiel T, Zanow J, Teichgräber UKM, Aschenbach R. Image quality and safety of automated carbon dioxide digital subtraction angiography in femoropopliteal lesions: Results from a randomized single-center study. Eur J Radiol 2020; 135:109476. [PMID: 33388532 DOI: 10.1016/j.ejrad.2020.109476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the image quality and the safety of automated carbon dioxide (CO2) digital subtraction angiography (DSA). MATERIALS AND METHODS Fifty patients receiving DSA for femoropopliteal peripheral arterial disease (PAD) were enrolled in this single-center prospective study. All patients received iodinated contrast media (ICM) and CO2 as a contrast agent in the same target lesion. As a primary endpoint, four raters independently evaluated the angiography images based on overall image quality, visibility of collaterals, and assessment of stenoses/occlusions. Inter-rater agreement was assessed using the intraclass correlation coefficient (ICC) and differences between the raters were evaluated using Friedmann's test. Secondary endpoints were procedure safety and patient pain assessment. RESULTS Inter-rater agreement between CO2-DSA and ICM-DSA images was fair to excellent for overall image quality (ICC: 0.399-0.748), fair to excellent for the visibility of collaterals (ICC: 0.513-0.691), and poor to excellent for the assessment of stenoses/occlusions (ICC: -0.065-0.762). There were no significant differences between the raters. Two patients had a hematoma, one reported pain related to puncture, one became nauseous, and one vomited. No other adverse events were observed. Reported pain scores were significantly higher for CO2-DSA vs. ICM-DSA (1.25 vs. 0625; p < 0.028). CONCLUSION CO2-DSA using automated injection system in combination with proprietary post-processing software is safe and comparable diagnostic test compared to ICM-DSA.
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Affiliation(s)
- F Bürckenmeyer
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Germany
| | - A Schmidt
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Germany
| | - I Diamantis
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Germany
| | - Thomas Lehmann
- Center for Clinical Studies, University Hospital Jena, Germany
| | - A Malouhi
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Germany
| | - T Franiel
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Germany
| | - J Zanow
- Clinic for General, Visceral and Vascular Surgery, University Hospital Jena, Germany
| | - U K M Teichgräber
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Germany
| | - R Aschenbach
- Department for Diagnostic and Interventional Radiology, University Hospital Jena, Germany.
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KATIRCIBAŞI MT, Özkan U. Tam Tıkalı Ana İliak Arterin; İonize Kontrast Madde Kullanmaksızın CO2’i Kontrast Ajan Olarak Kullanarak Endovasküler Yöntemle Tedavisi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2017. [DOI: 10.17517/ksutfd.314305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Stegemann E, Tegtmeier C, Bimpong-Buta NY, Sansone R, Uhlenbruch M, Richter A, Stegemann B, Roden M, Westenfeld R, Kelm M, Heiss C. Carbondioxide-Aided Angiography Decreases Contrast Volume and Preserves Kidney Function in Peripheral Vascular Interventions. Angiology 2015; 67:875-81. [PMID: 26535013 DOI: 10.1177/0003319715614701] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic kidney disease is a common comorbidity in patients with peripheral artery disease. We investigated the safety and efficacy of carbon dioxide (CO2) as supplemental contrast agent to decrease contrast volume during fluoroscopy-guided peripheral vascular procedures in routine angiological practice. We analyzed 191 consecutive interventions of the lower extremity in claudicants and critical limb ischemia (CLI) that were performed with iodinated contrast media (ICM) alone (n = 154) or with the aided or exclusive use of CO2 (n = 37). The technical success rate, total irradiation, and intervention time were not significantly different between ICM and CO2 No severe procedure-related complications occurred. The contrast volume was lower in CO2 than in ICM. Although kidney function, creatinine, and estimated glomerular filtration rate was lower in CO2 at baseline, the incidence of contrast-induced nephropathy was lower in CO2 compared to ICM. These data support CO2 as an alternative supplemental contrast agent that can be applied safely and efficiently to lower contrast volume during peripheral vascular interventions preventing kidney dysfunction even in patients with disease of the popliteal artery and below the knee and CLI.
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Affiliation(s)
- Emilia Stegemann
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Catharina Tegtmeier
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Nana Yaw Bimpong-Buta
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Roberto Sansone
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Mark Uhlenbruch
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Andreas Richter
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Berthold Stegemann
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Michael Roden
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Duesseldorf, Germany German Center for Diabetes Research, Partner Duesseldorf, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
| | - Christian Heiss
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Duesseldorf, Duesseldorf, Germany
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Contrast alternatives for iodinated contrast allergy and renal dysfunction: options and limitations. J Vasc Surg 2012; 57:593-8. [PMID: 23246079 DOI: 10.1016/j.jvs.2012.10.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/13/2012] [Accepted: 10/02/2012] [Indexed: 12/19/2022]
Abstract
Diagnostic angiography and vascular interventions make routine use of iodinated contrast material (ICM). Patients with renal disease or contrast allergy pose limitations on the use of ICM. In such cases, alternative contrast media may be used to carry out the procedure. Current alternatives include carbon dioxide, gadolinium, and dilute ICM. Each of these alternatives has its own unique features and limitations. In the present review article, the current alternatives to ICM are explored, with a focus on the applications and restrictions of each.
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Corazza I, Rossi PL, Feliciani G, Pisani L, Zannoli S, Zannoli R. Mechanical aspects of CO₂ angiography. Phys Med 2011; 29:33-8. [PMID: 22138139 DOI: 10.1016/j.ejmp.2011.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 10/13/2011] [Accepted: 11/12/2011] [Indexed: 12/17/2022] Open
Abstract
The aim of this paper is to clarify some physical-mechanical aspects involved in the carbon dioxide angiography procedure (CO₂ angiography), with a particular attention to a possible damage of the vascular wall. CO₂ angiography is widely used on patients with iodine intolerance. The injection of a gaseous element, in most cases manually performed, requires a long training period. Automatic systems allow better control of the injection and the study of the mechanical behaviour of the gas. CO₂ injections have been studied by using manual and automatic systems. Pressures, flows and jet shapes have been monitored by using a cardiovascular mock. Photographic images of liquid and gaseous jet have been recorded in different conditions, and the vascular pressure rises during injection have been monitored. The shape of the liquid jet during the catheter washing phase is straight in the catheter direction and there is no jet during gas injection. Gas bubbles are suddenly formed at the catheter's hole and move upwards: buoyancy is the only governing phenomenon and no bubbles fragmentation is detected. The pressure rise in the vessel depends on the injection pressure and volume and in some cases of manual injection it may double the basal vascular pressure values. CO₂ angiography is a powerful and safe procedure which diffusion will certainly increase, although some aspects related to gas injection and chamber filling are not jet well known. The use of an automatic system permits better results, shorter training period and limitation of vascular wall damage risk.
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Affiliation(s)
- Ivan Corazza
- Cardiovascular Dept., University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
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Patel BN, Kapoor BS, Borghei P, Shah NA, Lockhart ME. Carbon Dioxide as an Intravascular Imaging Agent: Review. Curr Probl Diagn Radiol 2011; 40:208-17. [DOI: 10.1067/j.cpradiol.2011.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Madhusudhan KS, Sharma S, Srivastava DN, Thulkar S, Mehta SN, Prasad G, Seenu V, Agarwal S. Comparison of intra-arterial digital subtraction angiography using carbon dioxide by 'home made' delivery system and conventional iodinated contrast media in the evaluation of peripheral arterial occlusive disease of the lower limbs. J Med Imaging Radiat Oncol 2009; 53:40-9. [PMID: 19453527 DOI: 10.1111/j.1754-9485.2009.02035.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
To prospectively compare the feasibility, safety and diagnostic role of carbon dioxide (CO(2)) digital subtraction angiography (DSA) using a 'home made' delivery system with iodinated contrast medium (ICM) DSA in the evaluation of peripheral arterial occlusive diseases (PAOD) of lower limbs. Twenty-one patients (27 limbs; all men; mean age, 47.6 years) who presented with PAOD of lower limbs underwent DSA using both intra-arterial CO(2) and ICM. Conventional ICM DSA was performed first and used as gold standard. Carbon dioxide was then injected by hand using a locally improvised home made plastic bag delivery system. Patient tolerance was assessed subjectively. Arteries from aortic bifurcation to the ankle were independently evaluated by two radiologists and graded for stenosis using a five-point scale. For each patient, the quality of CO(2) DSA images were compared with the corresponding images of ICM DSA and an overall grade of 'good', 'acceptable' or 'poor' was assigned. Cohen's kappa coefficient was used to determine inter-observer agreement. Carbon dioxide opacified 86.2% (188/195) of major arteries and depicted stenosis adequately in 84.5% (191/226) of arterial segments. A good or acceptable image quality of CO(2) DSA was obtained in over 95% of patients. Infrapopliteal arteries were inadequately visualized. Mild pain was seen in six (28.6%) patients with both contrast agents; one patient developed severe pain during CO(2) DSA. Inter-observer agreement was good (k > 0.75) at 70% of the segments. Administration of CO(2) into lower limb arteries is well tolerated. Carbon dioxide DSA using the locally improvised home made delivery system is a feasible and safe alternative to ICM DSA in the evaluation of PAOD. It provides adequate imaging of arteries of lower extremities except infrapopliteal segments.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Dehli, India
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Assessment of the Vessel Lumen Diameter and Degree of Stenosis in the Superficial Femoral Artery before Intervention: Comparison of Different Algorithms. J Vasc Interv Radiol 2009; 20:192-202. [DOI: 10.1016/j.jvir.2008.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 10/07/2008] [Accepted: 10/13/2008] [Indexed: 11/19/2022] Open
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Abstract
PURPOSE To determine prospectively the diagnostic performance of CO(2) venography, by using conventional venography with iodinated contrast material as the reference standard, for the preoperative evaluation of upper-limb and central veins before creation of fistulas for hemodialysis access. MATERIALS AND METHODS The study was approved by the institutional review board, and informed consent was obtained from all patients. Twenty-two patients underwent comparative CO(2) and conventional venography of upper-extremity and central veins. Two independent observers evaluated the opacification of the veins and grade of stenosis, if present. Interobserver agreements were estimated with the Cohen kappa coefficient. Calculations of sensitivity, specificity, and accuracy were used for intertechnique observations. RESULTS For CO(2) venography, global interobserver agreement was good, with a kappa value of 0.90 (range, 0.71-1.00; 95% confidence interval: 0.84, 0.95). A kappa value of 0.96 (range, 0.86-1.00; 95% confidence interval: 0.93, 0.99) was calculated for global interobserver agreement for conventional venography. The sensitivity, specificity, and accuracy of CO(2) venography for all vein segments were 97%, 85%, and 95%, respectively. CONCLUSION CO(2) venography had a sensitivity of 97% and a specificity of 85% in the assessment of upper-limb and central vein patency and stenosis, with conventional venography used as the reference standard.
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Affiliation(s)
- Sam Heye
- Department of Radiology, University Hospitals Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
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Abstract
The improvement of vascular imaging has allowed the acquisition of vascular images with higher resolution while minimizing the risks and discomfort to patients. As imaging developments continue to progress, establishment of valid clinical-based evidence, before the application of each innovation, will assure maintenance of the current trend. Also, as the vascular surgeon adopts a more comprehensive approach in the care of vascular patients, a high-quality endovascular suite will provide an environment for integration of both traditional open and evolving endovascular procedures.
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Affiliation(s)
- Vincent L Rowe
- Division of Vascular Surgery, Keck School of Medicine, LAC+USC Medical Center, University of Southern California, 1200 North State Street, Room 9442, Los Angeles, CA 90033, USA.
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Salis AI, Eclavea A, Johnson MS, Patel NH, Wong DG, Tennery G. Maximal Flow Rates Possible during Power Injection through Currently Available PICCs: An In Vitro Study. J Vasc Interv Radiol 2004; 15:275-81. [PMID: 15028813 DOI: 10.1097/01.rvi.0000116195.44877.88] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Currently available 4-F and 5-F peripherally inserted central catheters (PICCs) were investigated to evaluate their possible application for contrast medium injection using power injectors. The study was performed using an in vitro model to demonstrate the feasibility of using PICCs for contrast-enhanced diagnostic studies. MATERIALS AND METHODS An evaluation of 24 catheter versions consisting of 4-F single-lumen and 5-F dual-lumen PICCs from 13 different manufacturers was conducted. Six of the catheter types were silicone and 18 catheter types were polyurethane. Ten catheters of each type were evaluated with five at full length and five trimmed to 40 cm. With use of a silicone-based simulated SVC model, the catheters were infused with 50 mL of intravenous contrast medium at each flow rate increment. Catheters were tested at increasing flow rates from 0.5 to 5 mL/sec in 0.5-mL/sec increments using a Percupump CT injector. Catheters that failed to rupture were then infused at 1-mL/sec increments at flow rates from 5 to 17 mL/sec using a MedRad Mark V power injector. Tolerated and bursting pressures were recorded as well as the location of the catheter rupture. RESULTS Polyurethane catheters ruptured at flow rates between 4 and 15.4 mL/sec, with one catheter not rupturing at the maximal flow rate (17 mL/sec). Silicone catheters ruptured at flow rates between 0.5 to 3.5 mL/sec. Average rupture locations by type and length were at the extension leg/hub connection area on five of the PICCs, on the extension legs on 21 of the PICCs, on the catheter/hub connection on four PICCs, and on the proximal catheter on 16 of the PICCs. CONCLUSION The low burst rates at which all silicone catheters ruptured suggest that those catheters are not able to withstand typical flow rates used for CT arteriography. Conversely, although there is a wide range of discrepancy in the polyurethane catheter burst pressures, many polyurethane catheters can tolerate relatively high flow rates without rupture. This suggests that they may be safely used for CT arteriography with appropriate precautions and protocols in place.
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Affiliation(s)
- Ari I Salis
- Department of Radiology, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
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Brown DB, Pappas JA, Vedantham S, Pilgram TK, Olsen RV, Duncan JR. Gadolinium, carbon dioxide, and iodinated contrast material for planning inferior vena cava filter placement: a prospective trial. J Vasc Interv Radiol 2003; 14:1017-22. [PMID: 12902559 DOI: 10.1097/01.rvi.0000082865.05622.ad] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To prospectively compare the diagnostic accuracy of CO(2) and gadolinium to iodinated contrast material for inferior vena cavography before inferior vena cava (IVC) filter placement. MATERIALS AND METHODS Forty patients underwent injection of iodinated contrast material, CO(2), and gadolinium. Iodinated contrast material was used as the standard. Caval diameter was determined with calibrated software. Three readers blinded to contrast agent used measured the distance from the superior image border to the inferior margin of the renal veins and from the inferior image border to the iliac bifurcation. The measurements with CO(2) and gadolinium were compared to those with iodinated contrast material to obtain the interobserver and intraobserver variability. The presence or absence of caval thrombus and variant anatomy was noted. The same readers reexamined 12 studies in a separate session to determine intraobserver variability and correlation. RESULTS Caval diameter differed by 0.4 mm or less for all three agents. Measurements with all agents were within 2 mm of each other for all patients. Gadolinium and CO(2) were not significantly different from one another in measuring caval diameter. At the initial reading, compared with iodinated contrast material, gadolinium had greater mean interobserver error in measuring the distance to the iliac bifurcation and both renal veins (range, 1.6-1.8 mm) than CO(2) (range, 0.2-1.4 mm). This finding, although statistically significant for gadolinium (P <.05), was of doubtful clinical relevance. Interobserver correlation was significantly worse for CO(2) at the levels of the iliac bifurcation (P =.02) and right renal vein (P =.008). Interobserver correlation for gadolinium was similar to that for iodinated contrast material at all levels. At repeat reading, there was significantly inferior intraobserver correlation with use of CO(2) for both renal veins (P <.05) compared to iodinated contrast material and for the left renal vein (P <.05) compared to gadolinium. Gadolinium identified three of three renal vein anomalies identified with iodinated contrast material whereas CO(2) localized one of three. CONCLUSION CO(2) and gadolinium had limitations when compared with iodinated contrast material. Gadolinium provided superior consistency in identifying relevant landmarks for filter placement. CO(2) demonstrated significantly greater mean correlative error than gadolinium at initial and repeat readings.
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Affiliation(s)
- Daniel B Brown
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, Missouri 63110, USA.
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McLennan G, Moresco KP, Patel NH, Trobridge A, Dreesen J, Tennery J, Seshadri R, Johnson CS. Accuracy of CO(2) angiography in vessel diameter assessment: a comparative study of CO(2) versus iodinated contrast material in a porcine model. J Vasc Interv Radiol 2001; 12:985-9. [PMID: 11487680 DOI: 10.1016/s1051-0443(07)61580-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare, with use of intravascular ultrasound (IVUS) as an internal reference standard in a porcine model, arterial diameters measured from arteriograms obtained with use of CO(2) to those obtained with use of iodinated contrast material (ICM). MATERIALS AND METHODS In nine pigs, digital subtraction angiograms (DSAs) were obtained in the aorta and iliac arteries to compare vessel diameters measured with use of CO(2) to those measured with use of ICM. These measurements were divided by measurements made with use of intravascular ultrasound (IVUS) to yield a DSA/IVUS ratio. Differences between ICM and CO(2) were compared with analysis of variance to assess the effect of location (aorta vs iliac), contrast material used (ICM vs CO(2)), and position (posteroanterior, right anterior oblique, or left anterior oblique). Secondary analysis compared measurements of dependent and nondependent iliac arteries and compared the use of hand-injected CO(2) to that of CO(2) injected by an injector. RESULTS The DSA/IVUS ratio was 70.7% +/- 4.4% with ICM use and 69.6% +/- 6.3% with CO(2) use, which did not represent a significant difference (P =.311). Animal position had no effect (P =.477). Underestimation was worse in the iliac arteries than in the aorta (67.4% +/- 1.5% vs 71.4% +/- 1.7%; P =.038). There was no difference in nondependent (P =.163) arteries, but CO(2) underestimated dependent iliac artery size more than ICM did (66.3% +/- 4.8% vs 70.3% +/- 5.4%; P =.051). Vessel diameter was underestimated more with the CO(2) injector than with hand-injected CO(2) (64.3% +/- 2.3% vs 71.7% +/- 1.7%; P <.0001). CONCLUSION There is no difference in diameter underestimation between CO(2) and ICM in this animal model. Hand-injection of CO(2) causes less underestimation of vessel diameter than does the CO(2) injector.
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Affiliation(s)
- G McLennan
- Department of Radiology, Indiana University School of Medicine, University Hospital Room 0279, 550 N. University Blvd., Indianapolis, IN 46202-5253, USA.
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Le Blanche AF, Bazot MJ, Bonneau M, Farres MT, Wassef M, Levy B, Bigot JM, Boudghene F. Evaluation of renal arteries with use of gadoterate meglumine-, CO(2)-, and iodixanol-enhanced DSA measurements versus histomorphometry in renal artery restenosis in rabbits. J Vasc Interv Radiol 2001; 12:747-52. [PMID: 11389227 DOI: 10.1016/s1051-0443(07)61447-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To experimentally evaluate gadolinium (Gd)-, carbon dioxide (CO(2))-, and iodixanol-enhanced digital subtraction angiography (DSA) versus histomorphometry in the assessment of renal artery stenosis. MATERIALS AND METHODS Fifteen male New Zealand White rabbits weighing 4.0 kg underwent percutaneous catheterization. Renal artery stenosis was induced by bilateral overdilation-deendothelialization (balloon diameter = 2 mm). The percentage of artery overdilation was 33%. After 4 weeks, the rabbits were randomized into two groups: group A underwent right-sided therapeutic percutaneous transluminal renal angioplasty (PTRA) (balloon diameter = 1.5 mm). After another 4 weeks, the renal arteries were evaluated by gadoterate-, iodixanol-, and CO(2)-enhanced selective quantitative DSA. The rabbits were then killed and renal arteries were perfusion-fixed for 60 minutes. Serial orcein-stained 4-um-thick slices were prepared for histomorphometry. RESULTS Based on morphometric data of single-stenosis versus post-PTRA restenosis lesions, no significant difference was observed between Gd- and iodixanol-enhanced quantitative DSA (r(2) > 0.95), although the iodine/Gd density ratio was equal to 3.5. Carbon dioxide less reliably allowed quantitative DSA (r(2) < 0.75). CONCLUSION Gd-based contrast agents represent a highly reliable alternative in experimental quantitative DSA evaluation of renal artery restenosis.
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Affiliation(s)
- A F Le Blanche
- Department of Radiology and Medical Imaging, Charles Foix-Jean Rostand University Hospital, Ivry-sur-Seine, France.
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