Carbon Dioxide CO2 Angiography for Kidney-Sparing Vascular Imaging and Interventions: Scoping Review with ☸️SAIMSARA.

Name: SAIMSARA Evidence Object vascular::CO2_ANGIOGRAPHY_PM
Creator: SAIMSARA
License: https://saimsara.com/license/

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doi:10.62487/saimsara565e9b06

SAIMSARA Journal

Machine-Readable Science • ISSN 3054-3991

Carbon Dioxide CO2 Angiography for Kidney-Sparing Vascular Imaging and Interventions: Scoping Review with ☸️SAIMSARA.

Cardiac & Vascular Health

Issue 1, Volume 1, 2026

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DOI: 10.62487/saimsara565e9b06

Editorial note

• Last update: 2026-06-02 08:06:28

What is this paper about

CO2 angiography is not simply an “iodine-free alternative,” but a selective kidney-sparing imaging strategy with strongest value in CKD, contrast allergy, dialysis access, peripheral interventions, renal procedures, and EVAR. The full read clarifies where CO2 truly helps, where image quality fails—especially below the knee—and which rare but severe complications demand careful technique and patient selection.

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Abstract: To characterize the clinical uses, diagnostic and procedural performance, safety profile, technical refinements, and research gaps of CO2 angiography across human, animal, phantom, and bench-based original studies. The review uses 93 references and builds its evidence map from 105 original studies with 4202 total participants/sample observations (topic-deduplicated ΣN). This scoping review indicates that CO2 angiography supports a role as a context-dependent, kidney-sparing and allergy-avoiding contrast strategy rather than a universal substitute for iodinated contrast. The most consistent signal is benefit in renal-vulnerable or iodine-allergic patients undergoing peripheral, renal, dialysis-access, and EVAR procedures, exemplified by large series showing no significant renal-function impact across 1007 CO2 DSA procedures and reduction of iodinated contrast from 148 mL to 27 mL in azotemic EVAR. This utility is tempered by recurrent limitations in distal lower-limb image quality, patient discomfort, and rare but severe ischemic complications. Future work should prioritize prospective comparative trials with standardized safety and image-quality endpoints, particularly benchmarking optimized CO2 delivery against non-contrast MRA for below-knee territories, to clarify where CO2 angiography offers durable clinical advantage.

Keywords: Carbon dioxide angiography; Digital subtraction angiography; Peripheral arterial disease; Chronic kidney disease; Iodinated contrast; Contrast-induced nephropathy; Endovascular therapy; Renal angioplasty; Image quality; Vascular complications

Review Stats

Final search date and database lock: 2026-05-22 21:19:19 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 424
Downloaded Abstracts/Papers: 424
Included original and non-original Abstracts/Papers (all): 117
Included original Abstracts/Papers (Vote counting by direction of effect): 105
Reference Index (links used in paper): 93
Total participants/sample observations (topic deduplicated ΣN): 4202

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Reference Index (93)

[1] CO2 angiography for peripheral arterial imaging: the good, bad, and ugly. — https://doi.org/10.1002/ccd.25882
[2] Advanced Imaging Techniques for Complex Endovascular Aortic Repair: Preoperative, Intraoperative and Postoperative Advancements. — https://doi.org/10.1016/j.avsg.2024.06.003
[3] Angiography with carbon dioxide (CO2). — https://doi.org/10.1016/s0039-6109(05)70335-2
[4] CO2 digital angiography: a safer contrast agent for renal vascular imaging? — https://doi.org/10.1016/s0272-6386(12)80232-0
[5] Feasibility and safety of automated CO2 angiography in peripheral arterial interventions. — https://doi.org/10.1097/md.0000000000024254
[6] Carbon dioxide (CO2) digital subtraction angiography: 26-year experience at the University of Florida. — https://doi.org/10.1007/s003300050400
[7] Carbon Dioxide Angiography: Scientific Principles and Practice. — https://doi.org/10.5758/vsi.2015.31.3.67
[8] Carbon dioxide (CO2) angiography in children. — https://doi.org/10.1007/s002470050239

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