Dynamic Aortic Changes in Patients with Thoracic Aortic Aneurysms Evaluated with Electrocardiography-Triggered Computed Tomographic Angiography before and after Thoracic Endovascular Aneurysm Repair: Preliminary Results

Purpose: To report emergent endovascular repair of a ruptured abdominal aortic aneurysm (AAA) in a patient with a horseshoe kidney. Case Report: A 78-year-old man with a horseshoe kidney presented with a contained rupture of a 72-mm AAA. After urgent computed tomographic angiography (CTA) documented the blood supply to the kidney and the suitability of the aneurysm for endovascular repair, the patient was given a local anesthetic. An aortomonoiliac stent-graft constructed from components provided in a Talent Acute Endovascular Aneurysm Repair Kit was inserted successfully. The procedure was completed with placement of a contralateral common iliac artery occluder and a femorofemoral bypass graft. No complications were encountered, and the patient was discharged with an excluded aneurysm on the fourth postoperative day. At 3 months, aneurysm exclusion was confirmed by CTA, and no endoleak was present; the retroperitoneal hematoma had disappeared. The patient remains in good general condition 8 months after treatment Conclusions: The advantages of endovascular aneurysm repair in the emergency setting can facilitate rapid recovery in patients with symptomatic or ruptured aneurysms, especially those having a horseshoe kidney.

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Early Computed Tomographic Angiography after Endovascular Aneurysm Repair: Worthwhile or Worthless?

Vascular ◽

10.2310/6670.2008.00034 ◽

2008 ◽

Vol 16 (5) ◽

pp. 253-257 ◽

Cited By ~ 6

Author(s):

Evert J. Waasdorp ◽

Joost A. van Herwaarden ◽

Rob H.W. van de Mortel ◽

Frans L. Moll ◽

Jean-Paul P.M. de Vries

Keyword(s):

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Computed Tomographic Angiography ◽

Type I ◽

Type Ii ◽

Graft Thrombosis ◽

Computed Tomographic ◽

Tomographic Angiography ◽

Aneurysm Repair

This study evaluated the value of computed tomographic angiography (CTA) early after an endovascular aneurysm repair (EVAR) in relation to CTA 3 months after EVAR. We retrospectively reviewed all elective EVAR patients with available postprocedural and 3-month follow-up CTAs who were treated between 1996 and 2006. CTAs were analyzed for EVAR-related complications in terms of endoleaks, migration, and stent graft thrombosis. Secondary procedures and other complications within a 4-month time interval after EVAR were noted and analyzed for any association with the postprocedural CTA. During the study period, 291 patients (275 men), with a mean age of 71 years, underwent elective EVAR. All had postprocedural and 3-month follow-up CTAs, which detected 93 (32%) endoleaks (8 type I, 84 type II, 1 type III) and 1 stent graft thrombosis. These findings resulted in four secondary interventions (one interposition cuff, two extension cuffs, one conversion). All reinterventions were successfully done in an elective setting. During the first 3 postoperative months, five other reinterventions were required for acute ischemia in four patients (three Fogarty procedures, one femorofemoral crossover bypass) or groin infection in one patient. Eight patients died, but none of the deaths were related to abdominal aortic aneurysm or EVAR (four cardiac, two pulmonary, one gastric bleeding, one carcinoma). At 3 months, 43 endoleaks (3 type I, 40 type II), 3 stent graft thromboses, and 1 stent graft migration were seen. In two patients (0.7%), a new endoleak was diagnosed compared with the postprocedural CTAs. In 287 (99%) of 291 patients, the postprocedural CTA did not influence our treatment policy in the first 3 months after EVAR. More than half of the early endoleaks were self-limiting, and new endoleaks were seen in only two patients (< 1%) at the 3-month follow-up CTA. After an uneventful EVAR procedure, it is safe to leave out the early postprocedural CTA.

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Thoracic Endovascular Aneurysm Repair (TEVAR) for Ruptured Thoracic Aortic Aneurysms

Journal of Vascular and Endovascular Surgery ◽

10.21767/2573-4482.100046 ◽

2017 ◽

Vol 02 (02) ◽

Author(s):

Furlough CL ◽

Eskandari MK

Keyword(s):

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Thoracic Aortic Aneurysms ◽

Thoracic Endovascular Aneurysm Repair ◽

Aneurysm Repair

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Ultra-low-dose computed tomographic angiography with model-based iterative reconstruction compared with standard-dose imaging after endovascular aneurysm repair: a prospective pilot study

Abdominal Imaging ◽

10.1007/s00261-014-0166-1 ◽

2014 ◽

Vol 39 (6) ◽

pp. 1297-1303 ◽

Cited By ~ 4

Author(s):

Sailen G. Naidu ◽

J. Scott Kriegshauser ◽

Robert G. Paden ◽

Miao He ◽

Qing Wu ◽

...

Keyword(s):

Pilot Study ◽

Low Dose ◽

Standard Dose ◽

Endovascular Aneurysm Repair ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Prospective Pilot Study ◽

Tomographic Angiography ◽

Aneurysm Repair ◽

Dose Imaging

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Early Follow-Up After Endovascular Aneurysm Repair: Is the First Postoperative Computed Tomographic Angiography Scan Necessary?

Journal of Endovascular Therapy ◽

10.1583/11-3750.1 ◽

2012 ◽

Vol 19 (2) ◽

pp. 151-156 ◽

Cited By ~ 12

Author(s):

Kyriakos Oikonomou ◽

Felipe C. Ventin ◽

Kosmas I. Paraskevas ◽

Peter Geisselsöder ◽

Wolfgang Ritter ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Computed Tomographic Angiography ◽

Computed Tomographic ◽

Tomographic Angiography ◽

Aneurysm Repair

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Feeding Arteries of the Spinal Cord at CT Angiography before and after Thoracic Aortic Endografting

Journal of Endovascular Therapy ◽

10.1177/152660280701400507 ◽

2007 ◽

Vol 14 (5) ◽

pp. 639-649 ◽

Cited By ~ 13

Author(s):

Hendrik von Tengg-Kobligk ◽

Dittmar Böckler ◽

Tania M. Jose ◽

Marika Ganten ◽

Osos Kotelis ◽

...

Keyword(s):

Spinal Cord ◽

Maximum Intensity Projection ◽

Neurological Status ◽

Computed Tomographic Angiography ◽

Aortic Aneurysms ◽

Computed Tomographic ◽

Aortic Pathology ◽

Before And After ◽

Artery Of Adamkiewicz ◽

Tomographic Angiography

Purpose: To study the visualization of spinal cord feeding arteries in patients with complex thoracic aortic pathology undergoing endovascular aortic repair (EVAR) using an optimized protocol for multislice computed tomographic angiography (MSCTA). Methods: Eighteen consecutive patients (13 men; mean age 63 years, range 45–79) with aortic type B dissections (n=5), chronic expanding aortic dissections (n=5), thoracic aortic aneurysms (n=6), or penetrating aortic ulcers (n=2) underwent 16-slice CTA before and after (mean interval 9 days) EVAR. Pulse rate and neurological status were documented. Quantitative density measurements were taken at regions of interest (ROI) in the ascending thoracic aorta and at the level of the diaphragm. Two experienced radiologists qualitatively assessed the posterior intercostal arteries (PIA; fully visible, partially visible, non-visible), dorsal branches (DB; visible/non-visible), and artery of Adamkiewicz (AKA; visible/non-visible) on multiplanar reformations and maximum intensity projection reconstructions. Results: MSCTA was performed successfully in 17/18 patients before and after EVAR (1 patient was excluded after EVAR owing to rising creatinine levels). Before EVAR, MSCTA revealed 197/203 PIAs within the stented area, of which 179 were fully and 18 partially visible. No significant (p=0.37) difference was noted for overall PIA detection within the stented area on post-EVAR MSCTA (185/203 PIA), although only 124 were fully and 61 partially visible. Similar results were obtained for DB visualization. The AKA were seen in 10/17 patients pre EVAR and 9/17 post EVAR. In 2 patients, the AKA was localized within the stented aortic segment. ROI analysis revealed contrast densities of 427±89 HU and 398±84 HU on pre- and post-EVAR MSCTA, respectively. No neurological events were observed. Conclusion: The majority of posterior intercostal arteries and dorsal branches remain open after EVAR due to retrograde perfusion. High-resolution MSCTA permits accurate pre-and post-EVAR visualization of spinal cord feeding arteries in patients with thoracic aortic pathology.

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Anatomical Suitability of Ruptured Abdominal Aortic Aneurysms for Endovascular Repair

Journal of Endovascular Therapy ◽

10.1177/152660280301000309 ◽

2003 ◽

Vol 10 (3) ◽

pp. 453-457 ◽

Cited By ~ 29

Author(s):

Daniel F.G. Rose ◽

Ian R. Davidson ◽

Robert J. Hinchliffe ◽

Simon C. Whitaker ◽

Roger H. Gregson ◽

...

Keyword(s):

Endovascular Repair ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic Aneurysms ◽

Computed Tomographic Angiography ◽

Aortic Aneurysms ◽

University Hospital ◽

Aneurysm Neck ◽

Computed Tomographic ◽

Abdominal Aortic ◽

Ruptured Abdominal Aortic Aneurysms

Purpose: To assess the anatomical suitability of ruptured abdominal aortic aneurysms (AAA) for emergency endovascular repair. Methods: All cases (46 patients [35 men; mean age 74 years, range 54–85]) in which computed tomographic angiography (CTA) confirmed AAA rupture over a 5-year period at our university hospital were reviewed for anatomical suitability for endovascular repair. Measurements were made by a radiologist experienced in anatomical assessment of CT criteria for elective endovascular aneurysm repair (EVAR). Results: The mean aneurysm neck length was 18 mm (range 0–59); 17 were conical, 13 straight, 4 barrel, and 6 reverse conical. Six cases had no proximal neck. Overall, 37 (80%) patients were unsuitable for EVAR according to our criteria. Nearly half the patients (22, 48%) had ≥2 adverse features. Unsuitable neck morphology (35, 76%) was the primary reason for exclusion, but CIA aneurysm (10, 22%) and EIA tortuosity (7, 15%) were secondary adverse features. Conclusions: With current stent-graft design, the majority of ruptured abdominal aortic aneurysms are anatomically unsuitable for endovascular repair.

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