- “ Aortoiliac CTA provides relevant information on aortic root and iliofemoral vessel anatomy for preinterventional planning. CTA reveals clinically significant incidental findings in a high number of patients considered for transcutaneous aortic valve implantation, which may have a significant impact on patient selection.”
Aortoiliac CT Angiography for Planning Transcutaneous Aortic Valve Implantation: Aortic Root Anatomy and Fequency of Clinically Significant Incidental Findings
Apfaltrer P et al.
AJR 2012; 198:939-945 - “ Almost half the patients (101/207) had clinically significant incidental findings, including noncalcified pulmonary nodules larger than 8 mm (n=7), pulmonary embolism (n=3), or aortic aneurysm (n=12).”
Aortoiliac CT Angiography for Planning Transcutaneous Aortic Valve Implantation: Aortic Root Anatomy and Fequency of Clinically Significant Incidental Findings
Apfaltrer P et al.
AJR 2012; 198:939-945
- “Aortic aneurysm rupture, aortic dissection, PAU, acute aortic occlusion, traumatic aortic injury, and aortic fistula represent acute abdominal aortic conditions. Because of its speed and proximity to the emergency department, helical CT is the imaging test of choice for these conditions. MR imaging also plays an important role in the imaging of aortic dissection and PAU, particularly when the patient is unable to receive intravenous contrast material. In this era of MDCT, conventional angiography is used as a secondary diagnostic tool to clarify equivocal findings on cross-sectional imaging.”
CT of acute abdominal aortic disorders
Bhalla S et al.
Radiol Clin North Am 2003 Nov;41(6):1153-69 - “Acute aortic occlusion is a rare but catastrophic pathology resulting from thrombus formation, saddle embolism, false-lumen expansion in aortic dissection, aortic trauma, and other etiologies related to arteriosclerosis or hypercoagulability. Postoperative mortality is extremely high even if blood perfusion to the lower
extremities is restored by emergent surgical intervention.”
Acute Occlusion of the Abdominal Aorta with Concomitant Internal Iliac Artery Occlusion
Yamamoto H et al.
Annals of Thor and Cardiovasc Surg 17(4), 422-427, 2011-08-01 - “Studies have shown that the causes of death were attributed to a wide range of pathologies including respiratory failure (eg, respiratory distress syndrome), mesenteric ischemia, fatal arrhythmia, myocardial infarction, stroke, hyperkalemia, or renal failure, and most of the patients who died after revascularization appear to have had fatal organ failure even without obvious arterial occlusion in major organs.”
Acute Occlusion of the Abdominal Aorta with Concomitant Internal Iliac Artery Occlusion
Yamamoto H et al.
Annals of Thor and Cardiovasc Surg 17(4), 422-427, 2011-08-01 - “Prognosis of acute aortic occlusion is considerably poor. Postoperative mortality has been reported to be between 14% and 60% in the studies analyzing 10 or more patients with acute aortic occlusion.”
Acute Occlusion of the Abdominal Aorta with Concomitant Internal Iliac Artery Occlusion
Yamamoto H et al.
Annals of Thor and Cardiovasc Surg 17(4), 422-427, 2011-08-01
- Aortoenteric Fistulas: CT Findings
- Fistulae between native aorta and the adjacent bowel
- Hematoma may seen in the periaortic aorta
- Penetrating ulcer of the aorta is seen
- 80% of the fistulae involve the duodenum - Aortoenteric Fistulas: Clinical Findings
Gastrointestinal bleeding | 80% | Sepsis | 44% | Abdominal pain | 30% | Back pain | 15% | Groin mass | 12% | Abdominal pulsatile mass | 6% |
- Aortoenteric Fistulas: Facts
- Without surgical intervention mortality approaches 100%
- Primary fistula are rare and most cases are secondary and a result of aortic reconstructive surgery
- Secondary fistulae may occur between 2 weeks and 10 years post surgery "Although the CT features of aortoenteric fistula and perigraft infection often are similar, ectopic gas, loss of fat plane, extravasation of aortic contrast material into the enteric lumen, and leakage of enteric contrast material into the paraprosthetic space are highly suggestive of aortoenteric fistula in a patient with gastrointestinal bleeding." Aortoenteric Fistulas: CT Features and Potential Mimics
Vu QDM et al.
RadioGraphics 2009; 29: 197-209 - Aortoenteric Fistulas: Differential Dx
- Retroperitoneal fibrosis
- Infected aortic aneurysm
- Infectious aortitis
- Perigraft infection without fistulization "However the overall combined utilization rate of both types of AAA treatment has remained stable in the Medicare population. There is no evidence to suggest that the introduction of the newer approach has led to overteatment of patients." Endovascular Repair vs Open Surgical Repair of Abdominal Aortic Aneurysms: Comparitive Utilization Trends from 2001-2006
Levin DC et al.
J Am Coll Radiol 2009;6:506-509 "Treatment for AAA seems to be an example of the responsible use of new technology by physicians. The newer, less invasive and less risky procedure is replacing the older and more invasive procedure to a considerable degree." Endovascular Repair vs Open Surgical Repair of Abdominal Aortic Aneurysms: Comparitive Utilization Trends from 2001-2006
Levin DC et al.
J Am Coll Radiol 2009;6:506-509 - Abdominal Aortic Aneurysms: Facts
- Intervention indicated when size is = 5.5 cm
- Short term outcome improved with endovascular stents but long term is not significantly different than open repair
- "Aortic body paragangliomas are accompanied by other synchronous paragangliomas in about 10% of cases."
Cross-Sectional Imaging of Paragangliomas of the Aortic Body and Other Thoracic Branchiomeric Paraganglia
Balcombe J et al.
AJR 2007; 188:1054-1058
- "Loeys-Dietz Syndrome manifests with aggressive vascular pathology. Aneurysms may form at a young age and have a propensity for arterial dissection. In addition, aneurysms rupture at diameters smaller than those used to dictate surgical intervention for other syndromes and disorders".
Loeys-Dietz Syndrome: MDCT Angiography Findings Johnson PT, Chen JK, Loeys BL, Dietz HC, Fishman EK AJR 2007;189; 226
- "The combination of arterial enhanced phase and unenhanced imaging performed at 1-month follow-up offers improved specificity and positive predictive values compared with arterial phase images alone. Delayed phase imaging does not significantly increase sensitivity for detection of endoleaks, but it does depict low flow endoleaks not seen on arterial enhanced phase."
Iezzi R et al. Radiology 2006;241:915-921.
- "The combination of arterial enhanced phase and unenhanced imaging performed at 1-month follow-up offers improved specificity and positive predictive values compared with arterial phase images alone."
Multidetector CT in Abdominal Aortic Aneurysm Treated with Endovascular Repair: Are Unenhanced and Delayed Phase Enhanced Images Effective for Endoleak Detection
Iezzi R et al.
Radiology 2006;241:915-921.
- "The combination of arterial enhanced phase and unenhanced imaging performed at 1-month follow-up offers improved specificity and positive predictive values compared with arterial phase images alone. Delayed phase imaging does not significantly increase sensitivity for detection of endoleaks, but it does depict low flow endoleaks not seen on arterial enhanced phase"
Multidetector CT in Abdominal Aortic Aneurysm Treated with Endovascular Repair: Are Unenhanced and Delayed Phase Enhanced Images Effective for Endoleak Detection?
Iezzi R et al.
Radiology 2006;241:915-921.
- "Delayed phase imaging does not significantly increase sensitivity for detection of endoleaks, but it does depict low flow endoleaks not seen on arterial enhanced phase."
Multidetector CT in Abdominal Aortic Aneurysm Treated with Endovascular Repair: Are Unenhanced and Delayed Phase Enhanced Images Effective for Endoleak Detection? Iezzi R et al. Radiology 2006;241:915-921.
- "Study results indicate that arterial phase imaging may not be necessary for the routine detection of endoleaks. Radiation exposure can be decreased by eliminating this phase."
Abdominal Aortic Aneurysm:Can the Arterial Phase at CT Evaluation after Endovascular Repair Be Eliminated to Reduce Radiation Dose?
Macari M et al.
Radiology 2006; 241:908-914.
- CTA for Endoleaks: What Phase(s) of Acquisition are Needed?
- Unenhanced phase
- Arterial phase
- Delayed phase
- "MDCT angiography is a reliable method for evaluating the aortoiliac and lower extremity arteries."
MDCT Compared with DSA for Assessment of Lower Extremity Arterial Occlusive Disease: Importance of Reviewing Cross-Sectional Images
Ota H et al.
AJR 2004; 182:201-209
- Pseudoaneurysms: Etiology
- Trauma
- Iatrogenic
- Infection - Abdominal Angina: Facts
- Female > male by 3-1
- Mean age is 60 years
- 18% of patients over age 65 have mesenteric arterial stenosis but few are symptomatic
- Caused by stenosis or occlusion of the celiac, SMA or IMA
- At least 2 of the vessels and often all 3 are involved
- Occurs 15-60 minutes after meals - What is abdominal angina?
Definition: abdominal angina is also known as chronic mesenteric ischemia, and is a syndrome of chronic arterial insufficiency of the intestine. Clinical symptoms are increased epigastric pain which typically occurs with increased demand for splanchnic blood flow after a meal. - "Multidetector row CT angiography with appropriate postprocessing techniques is highly effective for the diagnosis, evaluation, and treatment of suspected abdominal angina."
Multidetector Row CT Angiography in Patients with Abdominal Angina Cademartiri F et al. RadioGraphics 2004; 24:969-984 - "In patients with an acute abdomen, the coronal images may clarify confusing anatomy, add confidence to interpretation, and provide a perspective familiar to referring surgeons."
MDCT of Patients with Acute Abdominal Pain:A New Perspective Using Coronal Reformations from Submillimeter Isotrophic Voxels Paulson EK et al. AJR 2004;183:899-906 - In patients with acute abdominal pain, MDCT with coronal reformations from submillimeter isotrophic voxels provides a useful adjunct to axial images."
MDCT of Patients with Acute Abdominal Pain:A New Perspective Using Coronal Reformations from Submillimeter Isotrophic Voxels Paulson EK et al. AJR 2004;183:899-906
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