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White Paper No. 15/2011
Renaissance for CO2 in C-arm-based
angiography thanks to technological advances
Carbon dioxide (CO2) has long been
used as a negative contrast media in
vascular diagnostics. It is non-allergenic
and poses no threat to the thyroid
gland or kidneys, benefits that have
made it a popular choice in vascular
medicine, particularly in light of changing demographics.
Although Hawkins pioneered the clinical
application of CO2 in the 1990s, it did not
go on to enjoy widespread clinical use.
It soon became apparent that the first
generation of manual application systems made it difficult to control the exact amount and pressure of CO2. This
was further compounded by the risk of
contamination from the surrounding air
and the additional time needed to apply
CO2. In addition, the X-ray technology
and software available at the time did
not support high-quality images, especially in the OR.
Digital application systems have been available
for some years now. These new devices are
equipped with a redundant safety system, enabling medical professionals to repeatedly select
the exact dose and application pressure so they
can deliver CO2 safely, easily and quickly. German
companies Malek Medical GmbH, manufacturer
of the digital application system Inspect 2005R,
Fig. 1: Ziehm Vision RFD mobile C-arm
and Ziehm Imaging, leading provider of mobile
C-arms with digital flat-panel technology (Fig. 1)
have joined forces with the Vascular Center in
Chemnitz to bring about a renaissance in the
application of CO2 in diagnostics and endovascular therapy.
Close collaboration with the Vascular Center
in Chemnitz has enabled enormous advances in
endovascular procedures (such as Endovascular
Aneurysm Repair, EVAR) in particular. Optimized
software in the new generation of mobile
angiography units, combined with flat-detector
technology, has resulted in outstanding image
quality on a par with conventional subtraction
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White Paper No. 15/2011
angiography based on iodine contrast agents
(Fig. 2 and 3). Immediate conversion of negative
contrast images, coupled with the Inspect 2005R
computer-aided application offering rapid imaging
times, eliminates the need to post-process negative contrast images on the C-arm. Instant roadmapping capabilities mean that the immediate
performance of complex procedures using just
CO2 and a mobile C-arm from Ziehm Imaging has
become daily routine at the Vascular Center in
Chemnitz.
Fig. 2: Digital subtraction angiography (DSA)
of an abdominal aortic aneurysm with CO2 as the
contrast agent.
“We can perform complex EVAR procedures using
chimney and sandwich techniques quickly, easily
and to outstanding levels of quality thanks to the
C-arm’s CO2 capabilities. We intend to make CO2
our primary contrast agent in every procedure.
This lowers our costs and is safer for our patients,”
explains Dr. Sven Seifert, Head Physician at the
Vascular Center in Chemnitz.
Author: Dr. Sven Seifert, Head Physician,
Klinikum Chemnitz gGmbH (hospital for
thorax, vascular and endovascular surgery)
Fig. 3: Angiogram checking the successful
implantation of an aortic stent with CO2 as the
contrast agent.