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World J Cardiol. Sep 26, 2017; 9(9): 715-722
Published online Sep 26, 2017. doi: 10.4330/wjc.v9.i9.715
Use of carbon dioxide as an intravascular contrast agent: A review of current literature
Fahad Ali, Muhammad Asif Mangi, Hiba Rehman, Edo Kaluski
Fahad Ali, Division of Cardiology, Department of Medicine and Lehigh Valley Hospital, Allentown, PA 18105, United States
Muhammad Asif Mangi, Hiba Rehman, Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
Edo Kaluski, Division of Cardiology, Department of Medicine, Guthrie Robert Packer Hospital and Guthrie Health Services, Sayre, PA 18840, United States
Author contributions: All authors contributed to the manuscript equally; all authors read and approved the final manuscript.
Conflict-of-interest statement: None of the authors have any conflicts of interest relative to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fahad Ali, MD, Division of Cardiology, Department of Medicine and Lehigh Valley Hospital, P.O. Box 689, Allentown, PA 18105, United States. drfahadalis@yahoo.com
Telephone: +1-570-8673025
Received: January 11, 2016
Peer-review started: January 14, 2016
First decision: March 7, 2016
Revised: October 9, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: September 26, 2017
Processing time: 622 Days and 14.8 Hours
Abstract

Use of X-ray contrast allows us to differentiate between two or more adjacent structures on radiographic studies. The X-ray contrast agent can be the one with increase X-ray absorption, like iodine and a barium X-ray contrast agent or the one with decrease X-ray absorption like air and carbon dioxide contrast agent. Each contrast agent possesses different risks and benefits in various ways. Carbon dioxide as an intravascular contrast agent can be used as an alternative intravascular contrast agent and has superior results in some cases. In patients with renal dysfunction or iodinated contrast allergy, the use of Iodinated Contrast Agent poses the risk of considerable morbidity. Similarly, use of Gadolinium is discouraged in subject with severe renal dysfunction. Use of carbon dioxide (CO2) as an intravascular contrast, offers an alternative in such patients for certain procedures, as it is not nephrotoxic and it does not incite allergic reactions. It is inexpensive, readily available and due to its unique physical properties, it can be used to image a wide variety of vascular beds and chambers. The aim of this paper is to systemically review the current literature to describe the indications, contraindications, adverse effects, instruments, precautions, latest methodologies and data supporting for the use of CO2 as a contrast agent.

Keywords: Iodinated; Carbon dioxide; Contrast; Vascular; Gadolinium

Core tip: In patients with renal dysfunction or iodinated contrast allergy, use of iodinated contrast agent poses the risk of considerable morbidity. Similarly, use of gadolinium is discouraged in subject with severe renal dysfunction. Use of carbon dioxide (CO2) as an intravascular contrast offers an alternative in such patients for certain procedures, as it is not nephrotoxic and it does not incite allergic reactions. It is inexpensive, readily available and due to its unique physical properties it can be used to image a wide variety of vascular beds and chambers. This article describes the indications, contraindications, adverse effects, instruments, precautions, latest methodologies and data supporting for the use of CO2 as a contrast agent.