الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The aim of this study was to study the use of CO2 angiography in endovascular treatment of chronic lower limb ischemia as regard feasibility, safety, quality of images, technical success and complications.
Twenty patients were included in this study (13 males and 7 females) with mean age 60.70 year ± 6.68 SD. 17 patients were diabetics (85%), 14 patients were hypertensives (70%), 9 patients were smokers (45%) and none of studied cases had iodinated contrast allergy or severe renal impairment.
Nine patients were presented with rest pain (Rutherford class 4) and eleven patients had trophic changes and minor tissue loss (Rutherford class 5) with a mean pre-procedural Ankle Brachial Index of 0.54 ± 0.25 SD. Those 20 patients had 29 arterial lesions, as some patients had lesions at more than one level. These lesions were: 2 iliac stenotic lesions. 10 SFA lesions; 7 of them were SFA stenosis and the other 3 were short CTO ≤ 5 cm. 3 popliteal artery lesions; 2 of them were popliteal stenosis and the other lesion was short CTO < 3 cm. Lastly, 14 tibial lesions; 10 of them were stenosis in one of the tibial arteries and the other 4 lesions were long CTO ≥ 4 cm.
All patients were treated by angioplasty after imaging of the lower limb arteries using CO2 and ICM as contrast agents. Vital signs and any specific complaints from the patient during the procedure were noted. ABI was measured 24 hours following the endovascular procedure. Angiographic images taken by CO2 and ICM were assessed by two independent reviewers using ICM images as a gold standard and the overall quality of the CO2 images of each case was given a grade on a score of 10 degrees. According to the grades given to each image, 62.3% of CO2 images had comparable quality to ICM images, 32.8% of CO2 images were of lower quality than ICM and 4.9% of CO2 images were more superior to ICM. The mean overall quality of cases by CO2 angiography was 8.98 ± 0.70 SD and 9.05 ± 0.79 SD according to reviewer 1 and reviewer 2 respectively. The quality of CO2 images at regions without lesion was of equal quality to or better than the reference images taken by ICM in 96.3% of these images. Intra-class correlation coefficient (ICC) demonstrated a high degree of convergence of the two reviewers for assessing quality of images (ICC= 0.899 with CI= 0.77 – 0.96).