Weaver F A, Pentecost M J, Yellin A E, Davis S, Finck E, Teitelbaum G
Department of Surgery, University of Southern California School of Medicine, Los Angeles.
J Vasc Surg. 1991 Feb;13(2):266-72; discussion 272-3.
During an 18-month period 33 patients in whom there were contraindications to the use of iodinated contrast arteriography underwent 40 carbon dioxide/digital subtraction arteriograms for lower extremity ischemia (19), severe hypertension and renal insufficiency (12), or arterial aneurysm (2). Contraindications to iodinated contrast agents included renal insufficiency, congestive heart failure, and contrast hypersensitivity. Sixteen aortic, 15 iliac-femoral-popliteal-tibial, five aorta-iliac-femoral and four aorta-iliac-femoral-popliteal-tibial carbon dioxide/digital subtraction arteriography studies were performed. In 11 studies, imaging of selected arterial segments required the addition of 10 to 60 ml of dilute nonionic contrast. Guided by carbon dioxide/digital subtraction arteriography studies four femoral-tibial bypasses, three aneurysmorrhaphies, two aortorenal bypasses, one aortofemoral bypass and one femoral-femoral bypass were successfully performed in 11 patients. In addition, carbon dioxide/digital subtraction arteriography directed angioplasties of the common iliac (4), superficial femoral (6), popliteal (3), or tibioperoneal trunk (1) were performed in 10 patients. Complications of carbon dioxide/digital subtraction arteriography included transient deterioration in renal function in three patients in whom 20 ml of nonionic contrast was used, a nonfatal myocardial infarction after a popliteal percutaneous transluminal angioplasty in one patient, and transient tachypnea and tachycardia during a carbon dioxide/digital subtraction arteriography study in one patient. Diagnostic arteriograms are obtainable using carbon dioxide as the contrast agent. Carbon dioxide/digital subtraction arteriography permits patients with symptomatic arterial disease at high risk for contrast related complications to safely undergo arteriography and subsequent arterial reconstruction or endovascular intervention.
在18个月期间，33例存在使用碘化造影剂动脉造影禁忌证的患者接受了40次二氧化碳/数字减影动脉造影，用于诊断下肢缺血（19例）、重度高血压和肾功能不全（12例）或动脉瘤（2例）。碘化造影剂的禁忌证包括肾功能不全、充血性心力衰竭和造影剂过敏。进行了16例主动脉、15例髂股腘胫、5例主动脉髂股和4例主动脉髂股腘胫二氧化碳/数字减影动脉造影研究。在11项研究中，对选定动脉节段进行成像需要添加10至60毫升稀释的非离子型造影剂。在二氧化碳/数字减影动脉造影研究的指导下，11例患者成功进行了4例股胫旁路移植术、3例动脉瘤缝扎术、2例主动脉肾旁路移植术、1例主动脉股旁路移植术和1例股股旁路移植术。此外，10例患者进行了二氧化碳/数字减影动脉造影引导下的髂总动脉（4例）、股浅动脉（6例）、腘动脉（3例）或胫腓干（1例）血管成形术。二氧化碳/数字减影动脉造影的并发症包括3例使用2 ml非离子型造影剂的患者肾功能短暂恶化、1例患者在腘动脉经皮腔内血管成形术后发生非致命性心肌梗死、1例患者在二氧化碳/数字减影动脉造影研究期间出现短暂的呼吸急促和心动过速。使用二氧化碳作为造影剂可获得诊断性动脉造影。二氧化碳/数字减影动脉造影使有造影剂相关并发症高风险的有症状动脉疾病患者能够安全地接受动脉造影及随后的动脉重建或血管内介入治疗。
