2010 Volume 66 Issue 8 Pages 893-900
A percutaneous transvascular angioplasty (PTA) is performed to relieve failed vascular access for hemodialysis. Angiography using non-ionic iodinated contrast media is the imaging modality of choice for performing PTA. However, the use of iodinated contrast media is contraindicated for patients with a history of iodine allergy. Since 1920, carbon dioxide (CO2) has been used as a safe contrast medium in various studies. In CO2 shunt angiography for hemodialysis, visualization of the vascular structures was often suboptimal due to shunt-specific conditions, such as rapid flow and narrow diameter of the vessels. In the present report, we attempted an improvement of the visualization by injection of CO2 bubbles in view of the properties of CO2 (floating and low viscosity). The results indicated that the CO2 bubbles angiography clearly demonstrated the narrow vessels and stenotic portions that were not visualized by conventional CO2 angiography. In addition, the required volume of CO2 could be reduced in comparison with previous studies in the literature. Therefore, the method seemed to be effective in reducing exposure and preventing complication by CO2. Thus, CO2 bubbles angiography may be useful for shunt angiography and sequential angioplasty when experiencing shunt problems.