Livedo Reticularis and Bowel Ischemia after Carbon Dioxide Arteriography in a Patient with CREST Syndrome

For 30 years, CO2 gas has been used as a safe alternative to iodinated contrast agents for angiography in patients with renal insufficiency or allergy to iodine. CO2 angiography is well tolerated when performed properly, and serious complications are rare. However, severe complications may occur if the physical properties of CO2 and the specific pathophysiology of an individual patient are not carefully considered. The present report describes a case in which diffuse livedo reticularis, bowel ischemia, and renal insufficiency developed following CO2 angiography in a patient with CREST syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia).