Objective: The aim of this study is to inform about first experience with fistulography and phlebography using carbon dioxide as a contrast agent in patients with renal insufficiency. Material and methods: In the 9-month interval (3 - 12/2000) authors performed upper arm phlebo- graphy or fistulography of a dialysis shunt using carbon dioxide in 15 patients. Carbon dioxide alone or in a combination with the iodinated contrast medium were used. All patients were in the terminal stage of renal disease either waiting for haemodialysis before a shunt creation or with a malfunctioning shunt in dialysed patients with residual renal function. Results: All procedures were technically successful. Results were evaluated by two radiologists, both were experienced in shunt diagnostics and interventions. Central vein imaging was better than peripheral vein visualisation. When using carbon dioxide a tendency to overestimate stenoses was noticed. In case of an interventional procedure diagnoses were evaluated by angiography with iodinated contrast medium. There was one case of misdiagnosis with carbon dioxide (7%, n = 15). Authors had no serious procedure - related complications. In one patient cephalea with transient visual disturbance developed when an arteficial reflux into the vertebral artery occurred (7%, n = 15). Conclusion: Carbon dioxide is useful in upper extremity phlebography and dialysis shunt imaging. This contrast agent is safe for venous injection when the reflux into the vertebral artery is preserved.

        Key words: carbon dioxide - contrast agent - phlebography - fistulography