CardioVascular and Interventional Radiology

, Volume 41, Issue 7, pp 1106–1111 | Cite as

Balloon-Occluded Carbon Dioxide Gas Angiography for Internal Iliac Arteriography and Intervention

  • Mitsuhiro KishinoEmail author
  • Shuichiro Nakaminato
  • Yoshio Kitazume
  • Naoyuki Miyasaka
  • Toshifumi Kudo
  • Yukihisa Saida
  • Ukihide Tateishi
Technical Note



The usefulness of carbon dioxide (CO2) gas digital subtraction angiography (DSA) has been reported for patients with renal insufficiency and allergy to iodinated contrast agents. However, CO2 gas cannot replace the iodinated contrast agent in all cases owing to some disadvantages. We describe balloon-occluded CO2 DSA (B-CO2 DSA) as an improved CO2 DSA procedure for interventions in the internal iliac artery (IIA) region and compare the quality of images obtained using conventional CO2 DSA and B-CO2 DSA.

Materials and Methods

B-CO2 DSA-guided embolization was performed for one case of genital bleeding with an acute anaphylactic reaction to the iodinated contrast agent and for three cases of type II endoleaks after endovascular abdominal aortic aneurysm repair with renal dysfunction. A 9-mm occlusion balloon catheter was placed just after the orifice of the IIA. Then, 10–15 ml of CO2 gas was injected manually via the catheter with and without balloon occlusion. The quality of sequential digital subtraction angiograms was analyzed based on a scoring criterion.


In all four cases, image quality was improved with B-CO2 DSA; the poor quality of images without balloon occlusion was because of reflux of the CO2 gas.


B-CO2 DSA improves the image quality of CO2 DSA in the IIA region and is useful for vascular intervention.

Level of Evidence

Level IV.


Carbon dioxide gas Balloon-occluded digital subtraction angiography Anaphylactic reaction Renal dysfunction Internal iliac artery Endoleak 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Mitsuhiro Kishino
    • 1
    Email author
  • Shuichiro Nakaminato
    • 1
  • Yoshio Kitazume
    • 1
  • Naoyuki Miyasaka
    • 2
  • Toshifumi Kudo
    • 3
  • Yukihisa Saida
    • 1
  • Ukihide Tateishi
    • 1
  1. 1.Department of Diagnostic Radiology and Nuclear MedicineTokyo Medical and Dental UniversityTokyoJapan
  2. 2.Department of Perinatal and Women’s MedicineTokyo Medical and Dental UniversityTokyoJapan
  3. 3.Division of Vascular Surgery, Department of SurgeryTokyo Medical and Dental UniversityTokyoJapan

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