Rome. "Angiography is an instrumental test used to visualize the arteries or veins in our body. It involves puncturing an artery or vein and injecting a contrast medium, historically iodinated," explains Professor Mauro Gargiulo, Professor of Vascular Surgery at the University of Bologna and Director of the Vascular Surgery Unit at the IRCCS Policlinico Sant'Orsola. "It is a fundamental diagnostic tool for assessing arterial narrowing or dilation and for correctly designing a diagnostic-therapeutic pathway."
Iodinated contrast medium, however, presents problems in some patients. "Iodine allows us to delineate the arteries very well, but there are allergic patients for whom its use is contraindicated, and others in whom it can cause kidney problems," Gargiulo explains. "Iodinated contrast medium is eliminated through the kidneys and can cause damage to the parenchyma, with the risk of renal failure, especially in those with already compromised function."
Hence the search for an alternative. "In endovascular interventions, we observed that the abundant use of iodine could damage the kidneys, and we sought to reduce this risk," says the vascular surgeon. "Already in the early 2000s, some colleagues began using carbon dioxide as a contrast medium. From 2007 to 2016, the use of CO₂ increased internationally, especially in patients with renal failure undergoing vascular surgery."
Technological advances have done the rest. "Since 2016, we've been using automated carbon dioxide injection systems that have significantly improved the performance of CO₂ angiography," Gargiulo emphasizes. "In some centers, this technique has become routine not only for at-risk patients but also in the endovascular treatment of arterial disease, almost replacing iodinated angiography."
The professor, however, clarifies that this is not a contradiction. "It's not an approach against iodine, which we continue to use, but rather an expansion of diagnostic options," he explains. "In patients in whom iodine cannot be used, CO₂ angiography offers reliable, almost superimposable images and is a step forward in reducing procedural risks."
The safety issue associated with the use of a gas remains. "CO₂ floats in the blood, is eliminated through the lungs, and does not cause peripheral embolization problems," Gargiulo clarifies. "However, we pay close attention to the injection site: we do not use CO₂ in the upper part of the arterial tree, above the diaphragm, or in the arteries that carry blood to the brain, to avoid the theoretical risk of cerebral ischemia."
The method is already a standard practice in the National Health Service. "Not all vascular surgery centers are equipped with this system," concludes Gargiulo, "but at the Sant'Orsola Polyclinic we have been using it routinely since 2016, and other centers in Italy are adopting this technology."
Source EDITORIAL TEAM
Choose the social channel you want to subscribe to