There is a 4 to 11 % incidence of serum creatinine increase by more than 88 mmol/l after angiography with an iodinated contrast medium (ICM) in patients with creatinine levels between 132 and 352 mmol/l. The purpose of our study was to determine the effectiveness of routine use of CO2 as a contrast medium in angiography of the lower extremities in patients with renal insufficiency. Materials and methods: Lower extremity angiography was performed primarily using CO2 in the first group of 24 patients with an average serum creatinine of 283.5 mmol/l. Supplementary angiography was performed using ICM only when CO2 imaging was not successful. In this group eight patients (29 %) were regularly haemodialysed. Angiography with ICM was performed in second group of 40 patients with average creatinine levels of 153.9 mmol/l. Results: A complete lower extremity angiogram was made only with CO2 in 33 % of patients, one or two peripheral levels had to be evaluated with ICM, in another 50 % patients with an average ICM dose of 52.9 ml. The average dose of ICM in the second group was 152.75 ml. The serum creatinine increased by more than 88 mmol/l in 2 patients of the first and in three patients of the second group. In addition to the pre-existing renal insufficiency the patients had the following risk factors – diabetes mellitus, congestive heart failure, septic shock caused by ischaemic gangrene of the lower leg and aging. Conclusion: Using CO2 as contrast medium the average dose of ICM was 2.9 times lower in comparison with angiograms performed only with ICM. The use of reduced volumes of ICM to supplement CO2 angiography caused significant deterioration of pre-existing renal insufficiency in 8.3 %. This complication occurred in 7.5 % in the second group of patients with a lower degree of renal insufficiency.

        Key words: carbon dioxide – contrast medium, comparative study – digital subtraction angiography