The Current Status of the Use of Carbon Dioxide in Diagnostic and Interventional Angiographic Procedures

Since the first description of carbon dioxide (CO₂) angiography the indications for using CO₂ have been changing and the applications of CO₂ angiography evolving. This review covers the contemporary role of CO₂ angiography. CO₂ angiography can be considered according to whether it is likely to be better, equivalent to or worse than conventional iodinated contrast medium (ICM). Areas where CO₂ angiography offers distinct advantages over ICM will be emphasized. The limitations to using CO₂ and specific caveats will be discussed. The basic physical properties of CO₂ and avoidance of the complications of gas angiography will be considered. CO₂ gas is cheap, non-allergenic, and is not nephrotoxic. Unfortunately it is not a panacea, angiographic quality is reduced, it is not tolerated by every patient, and it cannot be used in every location. It is important to be pragmatic and to use conventional contrast or alternative imaging rather than struggling with suboptimal CO₂ angiography.