Carbon dioxide angiography during angioembolization for trauma patients increases the detection of active bleeding and leads to reliable hemostasis: a retrospective, observational study

Angiography with carbon dioxide (CO₂) has long been used as an alternative when iodine contrast media (ICM) cannot be used due to allergy to iodine or renal dysfunction. Conversely, CO₂ angiography is also known as a provocation method for active bleeding. In this study, we examined the efficacy of CO₂ angiography in angioembolization (AE) for trauma patients.

This was a single-center, retrospective, observational study of trauma patients who underwent AE at our facility between January 2012 and April 2023.

Within this period, 335 AEs were performed. CO₂ angiography was performed in 102 patients (30.4%), and in 113 procedures. CO₂angiography was used to provoke active bleeding which went undetected using ICM in 83 procedures, and to confirm hemostasis after embolization in 30 procedures. Of the 80 procedures wherein, active bleeding was not detected on ICM, 35 procedures (43.8%) were detected using CO₂. The spleen had the highest detection rate of active bleeding by CO₂ angiography among the organs. There were 4/102 (1.9%) patients with CO₂ contrast who underwent some form of reintervention. Two patients were re-embolized with n-butyl-2-cyanoacrylate because of recanalization after embolization with gelatin sponge. The other two patients had pseudoaneurysm formation which required reintervention, and CO₂ angiography was not used. Vomiting was the most common complication of CO₂ angiography in 10 patients (9.8%), whereas all were transient and did not require treatment.

CO₂ angiography of trauma patients may have a better detection rate of active bleeding compared with ICM, leading to reliable hemostasis.