Background: Traditional contrast media containing iodine remain the gold standard for vessel visualization
during endovascular procedures. On the other hand, their use has several side effects and implications and
may cause contrast medium-induced nephropathy. Carbon dioxide (CO2) angiography is an old alternative technique
used only for critical patients in order to prevent kidney damages or allergic reactions.
Zero contrast procedure: The availability of automated CO2 injectors has led to an increase in the use of CO2
angiography, providing an option for zero contrast interventions, preserving patient renal function and saving
costs for the hospital facility. Taking advantage of the properties of CO2 gas, it is possible to improve the performance
of some complex procedures such as atherectomy and the detection of type II endoleaks after EVARs.
However, a learning curve is needed to get good imaging, and learn about the qualities and limitations of the
Conclusions: The use of automatic delivery systems for CO2 angiography appears to be a good choice for the use
of CO2 as the first imaging option. The standardization of injection protocols and the extensive use of this technique
could lead to significant benefits both for the patient's prospects and health facilities.