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

• Published in: Journal of medical imaging and radiation oncology 2009-02, Vol.53 (1), p.40-49
• Main Authors: Madhusudhan, KS, Sharma, S, Srivastava, DN, Thulkar, S, Mehta, SN, Prasad, G, Seenu, V, Agarwal, S
• Format: Article
• Language: English
• Subjects: Adult; Aged; angiography extremity; Angiography, Digital Subtraction - methods; Arterial Occlusive Diseases - diagnostic imaging; carbon dioxide; Carbon Dioxide - administration & dosage; Contrast Media - administration & dosage; contrast medium; digital subtraction angiography; Female; Humans; Injections, Intra-Arterial; Iodine; Lower Extremity - blood supply; Lower Extremity - diagnostic imaging; Male; Middle Aged; peripheral vascular disease; Peripheral Vascular Diseases - diagnostic imaging; Reproducibility of Results; Sensitivity and Specificity
• ISSN: 1754-9477; 1754-9485
• DOI: 10.1111/j.1754-9485.2009.02035.x

Summary To prospectively compare the feasibility, safety and diagnostic role of carbon dioxide (CO2) 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 CO2 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 CO2 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 CO2 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 CO2 DSA. Inter‐observer agreement was good (k > 0.75) at 70% of the segments. Administration of CO2 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.