Introduction: The usefulness of carbon dioxide (CO2) gas digital subtraction angiography (DSA) has been reported for patients with renal insufficiency and allergy to iodinated contrast agents. However, CO2 gas cannot replace the iodinated contrast agent in all cases owing to some disadvantages. We describe balloon-occluded CO2 DSA (B-CO2 DSA) as an improved CO2 DSA procedure for interventions in the internal iliac artery (IIA) region and compare the quality of images obtained using conventional CO2 DSA and B-CO2 DSA.
Materials and methods: B-CO2 DSA-guided embolization was performed for one case of genital bleeding with an acute anaphylactic reaction to the iodinated contrast agent and for three cases of type II endoleaks after endovascular abdominal aortic aneurysm repair with renal dysfunction. A 9-mm occlusion balloon catheter was placed just after the orifice of the IIA. Then, 10-15 ml of CO2 gas was injected manually via the catheter with and without balloon occlusion. The quality of sequential digital subtraction angiograms was analyzed based on a scoring criterion.
Results: In all four cases, image quality was improved with B-CO2 DSA; the poor quality of images without balloon occlusion was because of reflux of the CO2 gas.
Conclusions: B-CO2 DSA improves the image quality of CO2 DSA in the IIA region and is useful for vascular intervention.
Level of evidence: Level IV.
Keywords: Anaphylactic reaction; Balloon-occluded digital subtraction angiography; Carbon dioxide gas; Endoleak; Internal iliac artery; Renal dysfunction.