{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T10:41:22Z","timestamp":1786444882066,"version":"build-2736575974"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      This systematic review aims to analyse the different safety aspects and evidence of CO\n                      <jats:sub>2<\/jats:sub>\n                      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 CO\n                      <jats:sub>2<\/jats:sub>\n                      on the risk reduction of contrast-associated acute kidney injury (CA-AKI).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eleven studies encompassing meta-analyses, randomised controlled trials, and comparative studies were included. The review found that CO\n                      <jats:sub>2<\/jats:sub>\n                      angiography is a safe alternative to ICM in various vascular applications, especially in patients at risk for CA-AKI. CO\n                      <jats:sub>2<\/jats:sub>\n                      is associated with a higher incidence of minor, non-serious adverse events compared to ICM. No critical dose for CO\n                      <jats:sub>2<\/jats:sub>\n                      is established, but safe administration protocols and measures were outlined. CO\n                      <jats:sub>2<\/jats:sub>\n                      demonstrated a lower incidence of CA-AKI in peripheral arterial disease (PAD) procedures, but evidence in endovascular aneurysm repair (EVAR) was less conclusive.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      CO\n                      <jats:sub>2<\/jats:sub>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>What safety aspects and evidence support CO2 use as a contrast agent in vascular applications instead of ICM<\/jats:italic>\n                      ?\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>CO2 angiography is safe when considering specific safety measures and clinical applications; evidence on the reduction of ICM volume and CA-AKI is limited<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>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<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-12001-5","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T16:57:10Z","timestamp":1758214630000},"page":"7680-7687","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Safety and evidence of CO2 as a vascular contrast agent as an alternative to iodine-based contrast media in vascular procedures: a systematic review by the ESUR Contrast Medium Safety Committee"],"prefix":"10.1007","volume":"35","author":[{"given":"Robert P.","family":"Wawer Matos Reimer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Reimer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8077-9306","authenticated-orcid":false,"given":"Andreas H.","family":"Mahnken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-France","family":"Bellin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Bertolotto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torkel","family":"Brismar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Correas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Deike-Hofmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilona A.","family":"Dekkers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remy W. F.","family":"Geenen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gertraud","family":"Heinz-Peer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo A.","family":"Mallio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aart J.","family":"van der Molen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo C.","family":"Quattrocchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Radbruch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giles","family":"Roditi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Romanini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Sebasti\u00e0","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fulvio","family":"Stacul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Clement","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"12001_CR1","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1152\/ajplegacy.1956.186.2.325","volume":"186","author":"MJ Oppenheimer","year":"1956","unstructured":"Oppenheimer MJ, Durant TM, Stauffer HM et al (1956) In vivo visualization of intracardiac structures with gaseous carbon dioxide. Am J Physiol 186:325\u2013334. https:\/\/doi.org\/10.1152\/ajplegacy.1956.186.2.325","journal-title":"Am J Physiol"},{"key":"12001_CR2","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1016\/j.jvs.2017.03.446","volume":"66","author":"MJ Sharafuddin","year":"2017","unstructured":"Sharafuddin MJ, Marjan AE (2017) Current status of carbon dioxide angiography. J Vasc Surg 66:618\u2013637. https:\/\/doi.org\/10.1016\/j.jvs.2017.03.446","journal-title":"J Vasc Surg"},{"key":"12001_CR3","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1016\/S0039-6109(05)70335-2","volume":"78","author":"MR Back","year":"1998","unstructured":"Back MR, Caridi JG, Hawkins J, Seeger JM (1998) Angiography with carbon dioxide (CO2). Surg Clin North Am 78:575\u2013591. https:\/\/doi.org\/10.1016\/S0039-6109(05)70335-2","journal-title":"Surg Clin North Am"},{"key":"12001_CR4","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1007\/s003300050400","volume":"402","author":"IF Hawkins","year":"1998","unstructured":"Hawkins IF, Caridi JG (1998) Cardiovascular radiology review article carbon dioxide (CO2) digital subtraction angiography: 26-year experience at the University of Florida. Eur Radiol 402:391\u2013402","journal-title":"Eur Radiol"},{"key":"12001_CR5","doi-asserted-by":"publisher","first-page":"19","DOI":"10.2214\/ajr.139.1.19","volume":"139","author":"IF Hawkins","year":"1982","unstructured":"Hawkins IF (1982) Carbon dioxide digital subtraction arteriography. AJR Am J Roentgenol 139:19\u201324. https:\/\/doi.org\/10.2214\/ajr.139.1.19","journal-title":"AJR Am J Roentgenol"},{"key":"12001_CR6","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/S0272-6386(12)80232-0","volume":"24","author":"IF Hawkins","year":"1994","unstructured":"Hawkins IF, Wilcox CS, Kerns SR, Sabatelli FW (1994) CO2 digital angiography: A safer contrast agent for renal vascular imaging?. Am J Kidney Dis 24:685\u2013694. https:\/\/doi.org\/10.1016\/S0272-6386(12)80232-0","journal-title":"Am J Kidney Dis"},{"key":"12001_CR7","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1016\/j.rcl.2009.07.002","volume":"47","author":"IF Hawkins","year":"2009","unstructured":"Hawkins IF, Cho KJ, Caridi JG (2009) Carbon dioxide in angiography to reduce the risk of contrast-induced nephropathy. Radiol Clin North Am 47:813\u2013825. https:\/\/doi.org\/10.1016\/j.rcl.2009.07.002","journal-title":"Radiol Clin North Am"},{"key":"12001_CR8","unstructured":"ACR (2024) Committee on drugs and contrast media ACR manual on contrast media 2024 ACR Committee on Drugs and Contrast Media. Available via https:\/\/geiselmed.dartmouth.edu\/radiology\/wp-content\/uploads\/sites\/47\/2024\/08\/ACR-contrast-2024.pdf"},{"key":"12001_CR9","doi-asserted-by":"publisher","first-page":"2856","DOI":"10.1007\/s00330-017-5247-4","volume":"28","author":"AJ van der Molen","year":"2018","unstructured":"van der Molen AJ, Reimer P, Dekkers IA et al (2018) Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients: recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 28:2856\u20132869","journal-title":"Eur Radiol"},{"key":"12001_CR10","doi-asserted-by":"publisher","first-page":"2845","DOI":"10.1007\/s00330-017-5246-5","volume":"28","author":"AJ van der Molen","year":"2018","unstructured":"van der Molen AJ, Reimer P, Dekkers IA et al (2018) Post-contrast acute kidney injury\u2014part 1: definition, clinical features, incidence, role of contrast medium and risk factors: recommendations for updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 28:2845\u20132855. https:\/\/doi.org\/10.1007\/s00330-017-5246-5","journal-title":"Eur Radiol"},{"key":"12001_CR11","unstructured":"European Society of Urogenital Radiology (2024) ESUR guidelines on contrast agents. Available via https:\/\/www.esur.org\/wp-content\/uploads\/2022\/03\/ESUR-Guidelines-10_0-Final-Version.pdf. Accessed 2 Sep 2024"},{"key":"12001_CR12","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1177\/1526602815605468","volume":"22","author":"G Koutouzi","year":"2015","unstructured":"Koutouzi G, Henrikson O, Roos H et al (2015) EVAR guided by 3D image fusion and CO2 DSA: a new imaging combination for patients with renal insufficiency. J Endovasc Ther 22:912\u2013917. https:\/\/doi.org\/10.1177\/1526602815605468","journal-title":"J Endovasc Ther"},{"key":"12001_CR13","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1016\/j.ejvs.2017.08.019","volume":"54","author":"A Chaudhuri","year":"2017","unstructured":"Chaudhuri A, Dey R (2017) Towards a contrast free approach at EVAR: a new look at an old tool\u2014CO2 angiography. Eur J Vasc Endovasc Surg 54:737. https:\/\/doi.org\/10.1016\/j.ejvs.2017.08.019","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"12001_CR14","doi-asserted-by":"crossref","unstructured":"Cho KJ, Hawkins IF (2007) Carbon dioxide angiography principles, techniques, and practices, 1st edn. informa healthcare. Routledge","DOI":"10.3109\/9781420016260"},{"key":"12001_CR15","doi-asserted-by":"publisher","first-page":"67","DOI":"10.5758\/vsi.2015.31.3.67","volume":"31","author":"KJ Cho","year":"2015","unstructured":"Cho KJ (2015) Carbon dioxide angiography: scientific principles and practice. Vasc Specialist Int 31:67\u201380. https:\/\/doi.org\/10.5758\/vsi.2015.31.3.67","journal-title":"Vasc Specialist Int"},{"key":"12001_CR16","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.jclinepi.2010.09.012","volume":"64","author":"GH Guyatt","year":"2011","unstructured":"Guyatt GH, Oxman AD, Kunz R et al (2011) GRADE guidelines: 2. framing the question and deciding on important outcomes. J Clin Epidemiol 64:395\u2013400. https:\/\/doi.org\/10.1016\/j.jclinepi.2010.09.012","journal-title":"J Clin Epidemiol"},{"key":"12001_CR17","doi-asserted-by":"publisher","first-page":"715","DOI":"10.4330\/wjc.v9.i9.715","volume":"9","author":"F Ali","year":"2017","unstructured":"Ali F, Mangi MA, Rehman H, Kaluski E (2017) Use of carbon dioxide as an intravascular contrast agent: a review of current literature. World J Cardiol 9:715\u2013722. https:\/\/doi.org\/10.4330\/wjc.v9.i9.715","journal-title":"World J Cardiol"},{"key":"12001_CR18","first-page":"261","volume":"19","author":"PB Dimakakos","year":"1998","unstructured":"Dimakakos PB, Stefanopoulos T, Doufas AG et al (1998) The cerebral effects of carbon dioxide during digital subtraction angiography in the aortic arch and its branches in rabbits. AJNR Am J Neuroradiol 19:261\u2013266","journal-title":"AJNR Am J Neuroradiol"},{"key":"12001_CR19","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1097\/01.RVI.0000153114.05700.61","volume":"16","author":"DB Kozlov","year":"2005","unstructured":"Kozlov DB, Lang EV, Barnhart W et al (2005) Adverse cerebrovascular effects of intraarterial CO2 injections: Development of an in vitro\/in vivo model for assessment of gas-based toxicity. J Vasc Interv Radiol 16:713\u2013726. https:\/\/doi.org\/10.1097\/01.RVI.0000153114.05700.61","journal-title":"J Vasc Interv Radiol"},{"key":"12001_CR20","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1002\/clc.4960190604","volume":"19","author":"CR Lambert","year":"1996","unstructured":"Lambert CR, De Marchena EJ, Bikkina M, Arcement BK (1996) Effects of intracoronary carbon dioxide on left ventricular function in swine. Clin Cardiol 19:461\u2013465. https:\/\/doi.org\/10.1002\/clc.4960190604","journal-title":"Clin Cardiol"},{"key":"12001_CR21","unstructured":"Young M, Mohan J (2024) Carbon dioxide angiography. Available via https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK534244\/. Accessed 15 Aug 2024"},{"key":"12001_CR22","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1007\/s00117-019-0533-6","volume":"59","author":"F Pedersoli","year":"2019","unstructured":"Pedersoli F, Bruners P, Kuhl CK, Schmitz-Rode T (2019) Current CO2 angiography. Radiologe 59:533\u2013540","journal-title":"Radiologe"},{"key":"12001_CR23","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.ejmp.2011.11.003","volume":"29","author":"I Corazza","year":"2013","unstructured":"Corazza I, Rossi PL, Feliciani G et al (2013) Mechanical aspects of CO2 angiography. Phys Med 29:33\u201338. https:\/\/doi.org\/10.1016\/j.ejmp.2011.11.003","journal-title":"Phys Med"},{"key":"12001_CR24","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/S1051-0443(97)70577-3","volume":"8","author":"JG Caridi","year":"1997","unstructured":"Caridi JG, Hawkins IF (1997) CO2 digital subtraction angiography: potential complications and their prevention. J Vasc Interv Radiol 8:383\u2013391. https:\/\/doi.org\/10.1016\/S1051-0443(97)70577-3","journal-title":"J Vasc Interv Radiol"},{"key":"12001_CR25","doi-asserted-by":"publisher","first-page":"76","DOI":"10.4330\/wjc.v12.i2.76","volume":"12","author":"A Gupta","year":"2020","unstructured":"Gupta A, Dosekun AK, Kumar V (2020) Carbon dioxide-angiography for patients with peripheral arterial disease at risk of contrast-induced nephropathy. World J Cardiol 12:76\u201390. https:\/\/doi.org\/10.4330\/wjc.v12.i2.76","journal-title":"World J Cardiol"},{"key":"12001_CR26","doi-asserted-by":"publisher","first-page":"264","DOI":"10.4103\/ejs.ejs_314_20","volume":"40","author":"AM Elboushi","year":"2020","unstructured":"Elboushi AM, Tawfik AM, Abouissa AH et al (2020) Carbon dioxide versus iodine contrast medium for endovascular revascularization of aortoiliac occlusive disease: a two-center randomized. Egypt J Surg 40:264\u2013271. https:\/\/doi.org\/10.4103\/ejs.ejs_314_20","journal-title":"Egypt J Surg"},{"key":"12001_CR27","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1177\/0003319715614701","volume":"67","author":"E Stegemann","year":"2016","unstructured":"Stegemann E, Tegtmeier C, Bimpong-Buta NY et al (2016) Carbondioxide-aided angiography decreases contrast volume and preserves kidney function in peripheral vascular interventions. Angiology 67:875\u2013881. https:\/\/doi.org\/10.1177\/0003319715614701","journal-title":"Angiology"},{"key":"12001_CR28","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.jvs.2023.03.029","volume":"78","author":"SR Lee","year":"2023","unstructured":"Lee SR, Ali S, Cardella J et al (2023) Carbon dioxide angiography during peripheral vascular interventions is associated with decreased cardiac and renal complications in patients with chronic kidney disease. J Vasc Surg 78:201\u2013208. https:\/\/doi.org\/10.1016\/j.jvs.2023.03.029","journal-title":"J Vasc Surg"},{"key":"12001_CR29","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1016\/j.ejvs.2024.11.011","volume":"69","author":"E Chisci","year":"2025","unstructured":"Chisci E, Ferrero E, Antonello M et al (2025) Editor\u2019s choice\u2014feasibility and safety of using carbon dioxide exclusively in regular endovascular aortic aneurysm repair: results of a multicentre, prospective, zero iodine contrast endovascular aneurysm repair study. Eur J Vasc Endovasc Surg 69:392\u2013402. https:\/\/doi.org\/10.1016\/j.ejvs.2024.11.011","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"12001_CR30","doi-asserted-by":"publisher","unstructured":"Ali M, Noureldin M, Kashef O El, Zaghlol H (2023) Safety and effectiveness of carbon dioxide contrast medium in infra-inguinal endovascular interventions for patients with chronic threatening lower limb ischemia and renal impairment: a multicentric trial. J Endovasc Ther. https:\/\/doi.org\/10.1177\/15266028231159241","DOI":"10.1177\/15266028231159241"},{"key":"12001_CR31","doi-asserted-by":"crossref","unstructured":"Zarkowsky DS, Hicks CW, Bostock IC et al (2016) Renal dysfunction and the associated decrease in survival after elective endovascular aneurysm repair. J Vasc Surg. 64, 1278\u20131285","DOI":"10.1016\/j.jvs.2016.04.009"},{"key":"12001_CR32","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.avsg.2012.10.001","volume":"27","author":"SG Huang","year":"2013","unstructured":"Huang SG, Woo K, Moos JM et al (2013) A prospective study of carbon dioxide digital subtraction versus standard contrast arteriography in the detection of endoleaks in endovascular abdominal aortic aneurysm repairs. Ann Vasc Surg 27:38\u201344. https:\/\/doi.org\/10.1016\/j.avsg.2012.10.001","journal-title":"Ann Vasc Surg"},{"key":"12001_CR33","doi-asserted-by":"publisher","first-page":"4634","DOI":"10.3390\/jcm13164634","volume":"13","author":"P Spath","year":"2024","unstructured":"Spath P, Caputo S, Campana F et al (2024) CO2 angiography in the standard and complex endovascular repair of the abdominal aorta\u2014a narrative review of the literature. J Clin Med 13:4634. https:\/\/doi.org\/10.3390\/jcm13164634","journal-title":"J Clin Med"},{"key":"12001_CR34","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.avsg.2016.06.028","volume":"39","author":"C de Almeida Mendes","year":"2017","unstructured":"de Almeida Mendes C, de Arruda Martins A, Teivelis MP et al (2017) Carbon dioxide as contrast medium to guide endovascular aortic aneurysm repair. Ann Vasc Surg 39:67\u201373. https:\/\/doi.org\/10.1016\/j.avsg.2016.06.028","journal-title":"Ann Vasc Surg"},{"key":"12001_CR35","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1016\/j.ejvs.2023.06.039","volume":"66","author":"EU Unal","year":"2023","unstructured":"Unal EU, Iscan HZ, Erol ME et al (2023) Carbon dioxide guided endovascular aortic aneurysm repair in impaired renal function: propensity score matched study. Eur J Vasc Endovasc Surg 66:521\u2013529. https:\/\/doi.org\/10.1016\/j.ejvs.2023.06.039","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"12001_CR36","doi-asserted-by":"publisher","unstructured":"Busutti M, Sensoni A, Vacirca A et al (2023) Renal benefits of CO2 as a contrast media for EVAR procedures: new perspectives on 1 year outcomes. J Endovasc Ther. https:\/\/doi.org\/10.1177\/15266028231162258","DOI":"10.1177\/15266028231162258"},{"key":"12001_CR37","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.avsg.2021.10.039","volume":"81","author":"A Vacirca","year":"2022","unstructured":"Vacirca A, Faggioli G, Mascoli C et al (2022) CO2 automated angiography in endovascular aortic repair preserves renal function to a greater extent compared with iodinated contrast medium. analysis of technical and anatomical details. Ann Vasc Surg 81:79\u201388. https:\/\/doi.org\/10.1016\/j.avsg.2021.10.039","journal-title":"Ann Vasc Surg"},{"key":"12001_CR38","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.avsg.2023.10.009","volume":"101","author":"S Quaglino","year":"2024","unstructured":"Quaglino S, Ferrero E, Ferri M et al (2024) Safety, effectiveness and pitfalls of carbon dioxide routine use as a contrast agent for endovascular abdominal aortic repair. Ann Vasc Surg 101:120\u2013126. https:\/\/doi.org\/10.1016\/j.avsg.2023.10.009","journal-title":"Ann Vasc Surg"},{"key":"12001_CR39","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1002\/ccd.27051","volume":"90","author":"SS Ghumman","year":"2017","unstructured":"Ghumman SS, Weinerman J, Khan A et al (2017) Contrast induced-acute kidney injury following peripheral angiography with carbon dioxide versus iodinated contrast media: a meta-analysis and systematic review of current literature. Catheter Cardiovasc Interv 90:437\u2013448. https:\/\/doi.org\/10.1002\/ccd.27051","journal-title":"Catheter Cardiovasc Interv"},{"key":"12001_CR40","doi-asserted-by":"publisher","first-page":"7203","DOI":"10.3390\/jcm11237203","volume":"11","author":"G Wagner","year":"2022","unstructured":"Wagner G, Glechner A, Persad E et al (2022) Risk of contrast-associated acute kidney injury in patients undergoing peripheral angiography with carbon dioxide compared to iodine-containing contrast agents: a systematic review and meta-analysis. J Clin Med 11:7203. https:\/\/doi.org\/10.3390\/jcm11237203","journal-title":"J Clin Med"},{"key":"12001_CR41","first-page":"100445","volume":"1","author":"A Prasad","year":"2022","unstructured":"Prasad A, Palevsky PM, Bansal S et al (2022) Management of patients with kidney disease in need of cardiovascular catheterization: a scientific workshop cosponsored by the National Kidney Foundation and the Society for Cardiovascular Angiography and Interventions. J Soc Cardiovasc Angiogr Interv 1:100445","journal-title":"J Soc Cardiovasc Angiogr Interv"},{"key":"12001_CR42","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.3390\/life15071046","volume":"15","author":"T Wittig","year":"2025","unstructured":"Wittig T, Fischer S, Winther B et al (2025) Acute kidney injury after peripheral interventions using carbon dioxide angiography\u2014risk factors beyond iodinated contrast media. Life 15:1046. https:\/\/doi.org\/10.3390\/life15071046","journal-title":"Life"},{"key":"12001_CR43","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.carpath.2017.06.004","volume":"30","author":"AM Chopra","year":"2017","unstructured":"Chopra AM, Mehta M, Bismuth J et al (2017) Polymer coating embolism from intravascular medical devices\u2014a clinical literature review. Cardiovasc Pathol 30:45\u201354","journal-title":"Cardiovasc Pathol"},{"key":"12001_CR44","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.jvs.2007.03.039","volume":"46","author":"MS Edwards","year":"2007","unstructured":"Edwards MS, Corriere MA, Craven TE et al (2007) Atheroembolism during percutaneous renal artery revascularization. J Vasc Surg 46:55\u201361. https:\/\/doi.org\/10.1016\/j.jvs.2007.03.039","journal-title":"J Vasc Surg"},{"key":"12001_CR45","doi-asserted-by":"publisher","first-page":"e287","DOI":"10.1016\/j.amjmed.2017.01.032","volume":"130","author":"RI Mehta","year":"2017","unstructured":"Mehta RI, Mehta RI (2017) Hydrophilic polymer embolism: an update for physicians. Am J Med 130:e287\u2013e290","journal-title":"Am J Med"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-025-12001-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-025-12001-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-025-12001-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T11:44:07Z","timestamp":1763639047000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-025-12001-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":45,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["12001"],"URL":"https:\/\/doi.org\/10.1007\/s00330-025-12001-5","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,18]]},"assertion":[{"value":"2 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 August 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 August 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 September 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Peter Reimer.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare relationships with the following companies: Robert Wawer Matos Reimer: none. Peter Reimer: none. Andreas H. Mahnken: Bayer Healthcare. Marie-France Bellin: member of the Advisory Editorial Board of European Radiology (European Society of Urogenital Radiology). As such, M.-F.B. has not participated in the selection or review processes for this article. Michele Bertolotto: none. Torkel Brismar: member of the Scientific Editorial Board of European Radiology (Section Editor: Contrast Media). As such, T.B. has not participated in the selection or review processes for this article. Olivier Clement: Bracco Imaging, Guerbet, Bayer Healthcare. Jean-Michel Correas: Bracco Imaging, Guerbet. Katerina Deike-Hofmann: none. Ilona A. Dekkers: none. Remy W.F. Geenen: none. Gertraud Heinz: none. Carlo A. Mallio: none. Aart J. van der Molen: none. Carlo C. Quattrocchi: Bracco Imaging, Guerbet, Bayer Healthcare, GE Healthcare. Alexander Radbruch: Bracco Imaging, Guerbet, Bayer Healthcare, GE Healthcare. Giles Roditi: none. Laura Romanini: none. Carmen Sebasti\u00e0: none. Fulvio Stacul: none. Medical Affairs specialists of the contrast media companies Bayer Healthcare, Bracco Imaging, GE Healthcare and Guerbet are consultants to the Contrast Media Safety Committee and participate in all scientific discussions but are not involved in the final recommendations.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Basic statistics.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Not applicable.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}