chapter  9
12 Pages

CO2 Digital Subtraction Angiography of Tumors

WithKyung J. Cho

CO2 digital subtraction angiography (DSA) can be useful to guide various vascular

oncologic interventions. CO2 should be employed as a contrast agent in patients with

renal failure and hypersensitivity to iodinated contrast medium. The low viscosity of

CO2 allows the injection of the gas using a 3-F microcatheter, thus facilitating super-

selective catheterization and interventions. We have successfully used CO2 as a contrast

agent in the following procedures: selective arterial embolization of the hepatic, renal,

and bone tumors, placement of a hepatic arterial infusion catheter, embolization of

the gastroduodenal artery to decrease gastrointestinal symptoms in hepatic arterial

chemotherapy, hepatic arterial redistribution in the presence of an aberrant hepatic

artery, evaluation of a malfunctioning hepatic arterial pump, and preoperative portal

vein embolization. Because of the low viscosity of the gas, CO2 can demonstrate subtle

tumor vessels and arteriovenous shunting. A large volume of CO2 may be used safely

if the injections of the gas are separated by two to three minutes. The plastic bag

system is very useful for CO2 delivery since most procedures will require multiple

injections. Arterial portography cannot be obtained with CO2 because the gas will not

enter the venous system through the capillaries in quantities sufficient for a diagnostic

imaging.