chapter  7
14 Pages

CO2 Renal Digital Subtraction Angiography

WithIrvin F. Hawkins

CO2 has been very effective for visualization of the proximal renal arteries, with

reliable imaging in over 1200 aortograms. The distal renal arteries are frequently not as

well seen secondary to poor filling (buoyancy) and to overlying bowel gas. Presently

for aortograms we are injecting 30-40 cc of CO2 with a plastic bag delivery system

without nausea or abdominal pain. Because of the concerns for intestinal ischemia, we

limit the number of aortic injections to one supine anteroposterior (AP) and one or two

injections with the side of interest elevated. If filling is suboptimal, selective injections are

attempted, or we obtain lateral decubitus cross table injections, which will always fill

the non-dependent renal artery if patent. Although the majority of our studies have been

performed in patients with preexisting conditions (many diabetics), we have experi-

enced no cases of increased renal failure when procedural complications did not occur.