Carbon dioxide (CO2) angiography in children

When iodinated contrast material is contraindicated, carbon dioxide (CO2) gas can be injected intravascularly to produce high-quality digital subtraction angiograms. CO2 angiography, although previously described in adults, has never before been reported in children. We present three children with renal transplants who required renal angiography. Because of elevated creatinine levels, iodinated contrast was not used to search for possible renal artery stenosis. Instead, CO2 angiography was used to evaluate the renal artery anastomosis. In all three cases, the renal artery anastomosis was clearly visualized using CO2 angiography and showed no evidence of renal artery stenosis. Digital CO2 angiography is an effective method for pediatric renal angiography. The technique can easily be adapted for virtually any angiographic laboratory capable of digital subtraction imaging. Digital CO2 angiography also lacks the risks of a conventional iodinated contrast medium, namely nephrotoxicity, allergic reaction and volume overload.