Purpose: To compare the diagnostic ability and usefulness of carbon dioxide arteriography with that of angiography using iodinated contrast medium in ischemia of the lower extremities.
Methods: Between April 1997 and February 1998 arteriography was performed systematically in 50 consecutive patients (42 men, eight women; average age, 65 years), who presented with peripheral vascular disease of the arteries of the lower extremities, with use of both CO2 and iodinated contrast medium. Untoward events that occurred during the examinations and the resulting clinical problems were recorded. Subsequently, two radiologists carried out a double-blind evaluation of the images obtained for each segment (aorta, pelvis, thighs, knees, legs, and feet) using the two different contrast agents to diagnose the arterial condition (normal, aneurysm, stenosis, and occlusion). Afterward, the two types of study performed for each patient were compared to assess the overall quality of CO2 arteriography as opposed to arteriography performed with use of iodinated contrast material.
Results: Forty-eight percent of the patients reported discomfort during the CO2 examinations and 18% of the studies had to be discontinued as a result. When problems relating to poor image quality were included, only 36% of the arteriograms obtained with use of CO2 were complete. Evaluation was possible in only 25% of CO2 studies of the feet. On average, the overall quality of the arteriograms obtained with use of CO2 was insufficient for diagnosis.
Conclusion: In the authors' experience, CO2 arteriography cannot replace procedures performed with use of iodinated contrast medium for routine examination of ischemia of the lower limbs. In most cases, because of lower tolerance to the procedure and poorer image quality, CO2 imaging was not of sufficient quality to permit diagnosis, particularly at the infrapopliteal level.