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 (CO
2) has been used as a safe contrast medium in various studies. In CO
2 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 CO
2 bubbles in view of the properties of CO
2 (floating and low viscosity). The results indicated that the CO
2 bubbles angiography clearly demonstrated the narrow vessels and stenotic portions that were not visualized by conventional CO
2 angiography. In addition, the required volume of CO
2 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 CO
2. Thus, CO
2 bubbles angiography may be useful for shunt angiography and sequential angioplasty when experiencing shunt problems.
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