Tulane doctors’ innovation reduces risks for patients with diabetes, cardiovascular disease

People who suffer from diabetes or other kidney problems in addition to cardiovascular disease have a new, safer option for cardiovascular imaging studies thanks to an innovative technology being used by physicians with Tulane Health System. These special angiograms use carbon dioxide in the place of traditional iodinated contrast, or dye, which can greatly reduce the impact of the scan on patients’ kidneys.

Tulane interventional radiologists partner with cardiologists to perform the procedure, which provides images of blockages in the patient’s circulatory system.

“With an aging population and an increase in diabetes rates, it is estimated that 27 million people in North America and Europe suffer from atherosclerosclerotic peripheral arterial disease,” said Dr. James Caridi, an interventional radiologist and one of the pioneers of the carbon dioxide angiography procedure. “Approximately one third of these patients also suffer from diabetes and chronic kidney and heart disease. This places these patients at increased risk for kidney damage when traditional angiography and vascular intervention are necessary.

“But those patients also need more frequent scans to treat and monitor their condition. It’s a catch-22 – they need more imaging studies, but often, those scans can adversely affect their kidneys and make their problems worse. So we’ve worked to find a better way.”

Frequent scans using contrast can cause contrast-induced nephropathy, or kidney damage. In the CO2 procedure, a small amount of carbon dioxide is injected in the bloodstream instead of contrast to highlight the blood vessels and any blockages. The carbon dioxide is dissolved in the blood and then eliminated through the patient’s lungs.

“We are very fortunate to have a team of cardiologists who work hand-in-hand with interventional radiologists to develop innovations like this,” said Dr. Owen Mogabgab, a cardiologist with the Tulane Heart and Vascular Institute. “This is exactly the kind of innovation an academic medical center like Tulane can cultivate.”

Tulane physicians are among the first in the region to offer this technology, which is especially beneficial to the organ transplant patients of the Tulane Transplant Institute. With the largest group of CO2-trained physicians in the state, Tulane doctors are often successful in preventing amputations and other complications associated with chronic diabetes and kidney issues.

“One of our main goals right now is helping educate physicians and patients that this alternative exists,” Dr. Caridi said. “It’s on the cutting edge, so some people just aren’t aware there are options in addition to contrast.”

That may change this summer when Dr. Caridi chairs the New Cardiovascular Horizons CO2 Angiography Society’s annual conference on June 4 in New Orleans, an educational opportunity for healthcare professionals from across the nation.

“CO2 is helping prevent complications and allowing for angiograms and other procedures for patients who were previously unable to receive them,” said Dr. Brookes Ezell, a Tulane interventional radiologist. "In many cases, this technology is providing new opportunities for care to people who had frankly run out of options.”