Wawer Matos Reimer Robert P, Reimer Peter, Mahnken Andreas H, Bellin Marie-France, Bertolotto Michele, Brismar Torkel, Correas Jean-Michel, Deike-Hofmann Katerina, Dekkers Ilona A, Geenen Remy W F, Heinz-Peer Gertraud, Mallio Carlo A, van der Molen Aart J, Quattrocchi Carlo C, Radbruch Alexander, Roditi Giles, Romanini Laura, Sebastià Carmen, Stacul Fulvio, Clement Olivier
Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Department of Radiology, Institute for Diagnostic and Interventional Radiology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany.
Eur Radiol. 2025 Sep 18. doi: 10.1007/s00330-025-12001-5.
This systematic review aims to analyse the different safety aspects and evidence of CO as a contrast agent in vascular applications as an alternative to iodine-based contrast media (ICM). The review addresses clinical applications, contraindications, safety measures, and the impact of CO on the risk reduction of contrast-associated acute kidney injury (CA-AKI).
A systematic literature search was conducted across PubMed, Web of Science, Embase, and Cochrane Library, focusing on relevant literature centred around clinical questions by the Contrast Media Safety Committee of the European Society of Urogenital Radiology.
Eleven studies encompassing meta-analyses, randomised controlled trials, and comparative studies were included. The review found that CO angiography is a safe alternative to ICM in various vascular applications, especially in patients at risk for CA-AKI. CO is associated with a higher incidence of minor, non-serious adverse events compared to ICM. No critical dose for CO is established, but safe administration protocols and measures were outlined. CO demonstrated a lower incidence of CA-AKI in peripheral arterial disease (PAD) procedures, but evidence in endovascular aneurysm repair (EVAR) was less conclusive.
CO is a safe alternative to ICM in vascular procedures, potentially reducing the risk of CA-AKI, especially in PAD procedures. However, more large-scale RCTs are needed to confirm these findings and further investigate other risk factors contributing to CA-AKI in both EVAR and PAD procedures.
Question What safety aspects and evidence support CO2 use as a contrast agent in vascular applications instead of ICM? Findings CO2 angiography is safe when considering specific safety measures and clinical applications; evidence on the reduction of ICM volume and CA-AKI is limited. Clinical relevance CO2 angiography offers an alternative to ICM, especially in CA-AKI risk patients. More large-scale, multicentre RCTs are required to strengthen the evidence and to investigate other risk factors due to a high residual risk of CA-AKI when using CO2 angiography.
本系统评价旨在分析一氧化碳（CO）作为血管造影剂替代碘造影剂（ICM）在血管应用中的不同安全性方面及证据。该评价涉及临床应用、禁忌证、安全措施以及CO对降低造影剂相关急性肾损伤（CA-AKI）风险的影响。
在PubMed、科学网、Embase和Cochrane图书馆进行了系统的文献检索，重点关注欧洲泌尿生殖放射学会造影剂安全委员会围绕临床问题的相关文献。
纳入了11项研究，包括荟萃分析、随机对照试验和比较研究。该评价发现，在各种血管应用中，尤其是在有CA-AKI风险的患者中，CO血管造影是ICM的一种安全替代方法。与ICM相比，CO与轻微、非严重不良事件的发生率较高相关。尚未确定CO的临界剂量，但概述了安全给药方案和措施。在周围动脉疾病（PAD）手术中，CO导致CA-AKI的发生率较低，但在血管内动脉瘤修复（EVAR）中的证据不太确凿。
在血管手术中，CO是ICM的一种安全替代方法，有可能降低CA-AKI的风险，尤其是在PAD手术中。然而，需要更多大规模的随机对照试验来证实这些发现，并进一步研究在EVAR和PAD手术中导致CA-AKI的其他风险因素。
问题 哪些安全性方面和证据支持在血管应用中使用CO2替代ICM作为造影剂？ 发现 考虑到特定的安全措施和临床应用，CO2血管造影是安全的；关于减少ICM用量和CA-AKI的证据有限。 临床意义 CO2血管造影为ICM提供了一种替代方法，尤其是在有CA-AKI风险的患者中。由于使用CO2血管造影时CA-AKI的残留风险较高，需要更多大规模、多中心的随机对照试验来加强证据并研究其他风险因素。
