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@ARTICLE{WawerMatosReimer:282472,
      author       = {Wawer Matos Reimer, Robert P and Reimer, Peter and Mahnken,
                      Andreas H and Bellin, Marie-France and Bertolotto, Michele
                      and Brismar, Torkel and Correas, Jean-Michel and
                      Deike-Hofmann, Katerina and Dekkers, Ilona A and Geenen,
                      Remy W F and Heinz-Peer, Gertraud and Mallio, Carlo A and
                      van der Molen, Aart J and Quattrocchi, Carlo C and Radbruch,
                      Alexander and Roditi, Giles and Romanini, Laura and
                      Sebastià, Carmen and Stacul, Fulvio and Clement, Olivier},
      title        = {{S}afety and evidence of {CO}2 as a vascular contrast agent
                      as an alternative to iodine-based contrast media in vascular
                      procedures: a systematic review by the {ESUR} {C}ontrast
                      {M}edium {S}afety {C}ommittee.},
      journal      = {European radiology},
      volume       = {35},
      number       = {12},
      issn         = {0938-7994},
      address      = {Heidelberg},
      publisher    = {Springer},
      reportid     = {DZNE-2025-01295},
      pages        = {7680 - 7687},
      year         = {2025},
      abstract     = {This systematic review aims to analyse the different safety
                      aspects and evidence of CO2 as a contrast agent in vascular
                      applications as an alternative to iodine-based contrast
                      media (ICM). The review addresses clinical applications,
                      contraindications, safety measures, and the impact of CO2 on
                      the risk reduction of contrast-associated acute kidney
                      injury (CA-AKI).A systematic literature search was conducted
                      across PubMed, Web of Science, Embase, and Cochrane Library,
                      focusing on relevant literature centred around clinical
                      questions by the Contrast Media Safety Committee of the
                      European Society of Urogenital Radiology.Eleven studies
                      encompassing meta-analyses, randomised controlled trials,
                      and comparative studies were included. The review found that
                      CO2 angiography is a safe alternative to ICM in various
                      vascular applications, especially in patients at risk for
                      CA-AKI. CO2 is associated with a higher incidence of minor,
                      non-serious adverse events compared to ICM. No critical dose
                      for CO2 is established, but safe administration protocols
                      and measures were outlined. CO2 demonstrated a lower
                      incidence of CA-AKI in peripheral arterial disease (PAD)
                      procedures, but evidence in endovascular aneurysm repair
                      (EVAR) was less conclusive.CO2 is a safe alternative to ICM
                      in vascular procedures, potentially reducing the risk of
                      CA-AKI, especially in PAD procedures. However, more
                      large-scale RCTs are needed to confirm these findings and
                      further investigate other risk factors contributing to
                      CA-AKI in both EVAR and PAD procedures.Question What safety
                      aspects and evidence support CO2 use as a contrast agent in
                      vascular applications instead of ICM? Findings CO2
                      angiography is safe when considering specific safety
                      measures and clinical applications; evidence on the
                      reduction of ICM volume and CA-AKI is limited. Clinical
                      relevance CO2 angiography offers an alternative to ICM,
                      especially in CA-AKI risk patients. More large-scale,
                      multicentre RCTs are required to strengthen the evidence and
                      to investigate other risk factors due to a high residual
                      risk of CA-AKI when using CO2 angiography.},
      keywords     = {Contrast Media: adverse effects / Humans / Carbon Dioxide:
                      adverse effects / Carbon Dioxide: administration $\&$ dosage
                      / Iodine: adverse effects / Acute Kidney Injury: chemically
                      induced / Acute Kidney Injury: prevention $\&$ control /
                      Angiography: methods / Angiography: adverse effects / Acute
                      kidney injury (Other) / Angiography (Other) / Carbon dioxide
                      (Other) / Contrast media (Other) / Safety (Other) / Contrast
                      Media (NLM Chemicals) / Carbon Dioxide (NLM Chemicals) /
                      Iodine (NLM Chemicals)},
      cin          = {AG Radbruch},
      ddc          = {610},
      cid          = {I:(DE-2719)5000075},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40968298},
      doi          = {10.1007/s00330-025-12001-5},
      url          = {https://pub.dzne.de/record/282472},
}