Many patients with PAD have issues such as diabetes mellitus which can lead to kidney dysfunction. These patients are at risk to develop a condition known as contrast-induced nephropathy after being exposed to standard contrast agents during angiograms and interventions. This condition can lead to renal failure, short term dialysis, or even permanent dialysis. Many PAD patients already suffer from impaired kidney function and until now, they could not have potentially limb-saving procedures for the fear of being placed on dialysis. The use of CO2 angiography has changed this way of thinking and opened doors to treatment options not previously available.

Carbon dioxide is a non-toxic, compressible gas that has been available since the early 1900s. It has many advantages when compared to commonly used agents. Unlike iodinated contrast medium, there is no risk for allergic reaction. This makes CO2 an ideal adjunct to iodinated contrast medium for patients who have a history of allergic reactions. In addition, CO2 causes no renal toxicity. Studies indicate that the selective injection of CO2 is safe, even in patients with diabetes or compromised renal function. This makes it ideal for use in renal artery angioplasty and stent placement.

Furthermore, CO2 does not cause liver toxicity. CO2 has been used successfully as a contrast agent for celiac, splenic, superior mesenteric, and hepatic arteriograms for patients with a variety of disorders.

Overall, CO2 is a great option for patients with compromised renal function who need complex, peripheral vascular interventions.

Birmingham Heart Clinic, in conjunction with St. Vincent's East Hospital, is the first and only practice in Birmingham to use CO2 angiography in the treatment of peripheral arterial disease or PAD.

James Trimm, MD is an interventional cardiologist at Birmingham Heart Clinic.