Gupta Amol, Dosekun Akinsansoye K, Kumar Vinod
Department of Cardiology, Heart, Vascular and Leg Center, Bakersfield, CA 93309, United States.
Department of Nephrology, University of Texas, Houston, TX 77030, United States.
World J Cardiol. 2020 Feb 26;12(2):76-90. doi: 10.4330/wjc.v12.i2.76.
Patients with peripheral arterial disease (PAD) and critical limb ischemia are at risk for limb amputation and require urgent management to restore blood flow. Patients with PAD often have several comorbidities, including chronic kidney disease, diabetes mellitus, and hypertension. Diagnostic and interventional angiography using iodinated contrast agents provides excellent image resolution but can be associated with contrast-induced nephropathy (CIN). The use of carbon dioxide (CO) as a contrast agent reduces the volume of iodine contrast required for angiography and reduces the incidence of CIN. However, CO angiography has been underutilized due to concerns regarding safety and image quality. Modern CO delivery systems with advanced digital subtraction angiography techniques and hybrid angiography have improved imaging accuracy and reduced the incidence of CIN. Awareness of the need for optimal imaging conditions, contraindications, and potential complications have improved the safety of CO angiography. This review aims to highlight current technological advances in the delivery of CO in vascular angiography for patients with PAD and critical limb ischemia, which result in limb preservation while preventing kidney damage.
外周动脉疾病（PAD）和严重肢体缺血患者面临肢体截肢风险，需要紧急治疗以恢复血流。PAD患者常伴有多种合并症，包括慢性肾病、糖尿病和高血压。使用碘化造影剂的诊断性和介入性血管造影可提供出色的图像分辨率，但可能与造影剂肾病（CIN）相关。使用二氧化碳（CO）作为造影剂可减少血管造影所需的碘造影剂用量，并降低CIN的发生率。然而，由于对安全性和图像质量的担忧，CO血管造影的应用一直不足。采用先进数字减影血管造影技术和混合血管造影的现代CO输送系统提高了成像准确性，并降低了CIN的发生率。对最佳成像条件、禁忌症和潜在并发症的认识提高了CO血管造影的安全性。本综述旨在强调在为PAD和严重肢体缺血患者进行血管造影时，CO输送方面的当前技术进展，这些进展可在预防肾损伤的同时保留肢体。
