Placement of Endovascular Stent-Grafts for Emergency Treatment of Acute Disease of the Descending Thoracic Aorta
Benedikt V. Czermak1,
Peter Waldenberger1,
Reinhold Perkmann2,
Michael Rieger1,
Iris E. Steingruber1,
Ammar Mallouhi1,
Gustav Fraedrich2 and
Werner R. Jaschke1
1 Department of Radiology, Kurt Amplatz Center, Leopold-Franzens Medical School
and University Hospital Innsbruck, Anichstr. 35, 6020 Innsbruck,
Austria.
2 Department of Vascular Surgery, Leopold-Franzens Medical School and University
Hospital Innsbruck, 6020 Innsbruck, Austria.
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Fig. 1A. —41-year-old man (patient 16) with traumatic rupture of
thoracic aorta. CT scan obtained before transfemoral placement of stent-graft
shows false aneurysm (arrowheads) and mediastinal hematoma. In
addition, peritoneal fat (arrows) is seen in left hemithorax because
of ruptured left hemidiaphragm.
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Fig. 1B. —41-year-old man (patient 16) with traumatic rupture of
thoracic aorta. CT scan obtained after stent-graft placement shows complete
exclusion of false aneurysm. Adequate blood flow is seen in descending
thoracic aorta.
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Fig. 1C. —41-year-old man (patient 16) with traumatic rupture of
thoracic aorta. Angiogram obtained before intervention shows isthmic
pseudoaneurysm (solid arrows). Mild narrowing of left lateral wall of
left common carotid artery is caused by vasospasm (arrowheads). Left
vertebral artery arises from aortic arch (open arrows).
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Fig. 1D. —41-year-old man (patient 16) with traumatic rupture of
thoracic aorta. Angiogram obtained after intervention shows complete exclusion
of pseudoaneurysm. Noncovered portion of stent-graft is placed across origin
of left subclavian artery. Blood flow in artery (arrows) remains
intact.
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Fig. 2A. —30-year-old man (patient 14) with traumatic rupture of
thoracic aorta. Oblique transverse multiplanar volume reconstruction displayed
in average mode of distal thoracic aortic arch obtained after intervention
shows primary proximal attachment zone endoleak type I (arrows).
Stent-graft is not flexible enough to apply to curve of distal arch.
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Fig. 2B. —30-year-old man (patient 14) with traumatic rupture of
thoracic aorta. Oblique transverse multiplanar volume reconstruction displayed
in average mode of distal thoracic aortic arch obtained after insertion of
additional, more flexible stent-graft shows complete sealing of endoleak.
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Fig. 3A. —63-year-old man (patient 3) with acute Stanford type B
dissection. Three-dimensional volume-rendering reconstruction image of
thoracic stent-graft obtained after intervention shows stent-graft in true
lumen.
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Fig. 3B. —63-year-old man (patient 3) with acute Stanford type B
dissection. Three-dimensional volume-rendering reconstruction image of
thoracic stent-graft obtained 24 months after intervention shows expected
expansion, resulting in enlargement of true lumen during follow-up.
Instability in short overlapping area resulted in disconnection
(arrows). Short overlapping area increases risk of migration and
caused disconnection.
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Fig. 3C. —63-year-old man (patient 3) with acute Stanford type B
dissection. Three-dimensional volume-rendering reconstruction image of
thoracic stent-graft obtained after successful secondary interventional repair
shows that endoluminal therapy was possible by insertion of additional
stent-graft.
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Fig. 4A. —70-year-old man (patient 12) with acute Stanford type B
dissection. Angiogram obtained before intervention shows blood flow in true
and false lumina (arrowheads) of thoracic aorta.
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Fig. 4B. —70-year-old man (patient 12) with acute Stanford type B
dissection. Angiogram obtained after stent-graft deployment shows complete
closure of entry site (arrow).
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Fig. 5A. —45-year-old man (patient 11) with acute Stanford type B
dissection. Angiogram obtained before intervention shows "floating
viscera sign" representing severe underperfusion of visceral arteries
because dissection spares vessel origin, but dissection flap appears to
compress true lumen at or above origin and covers origin. During angiography
of true lumen, aorta fills minimally or not at all, but branch arteries fill
and appear to arise out of nowhere.
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Fig. 5B. —45-year-old man (patient 11) with acute Stanford type B
dissection. Angiogram obtained after stent-graft deployment shows normal blood
flow in visceral arteries.
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Fig. 6A. —72-year-old man (patient 10) with penetrating ulcer of
thoracic aorta. Posterior oblique volume-rendering reconstruction obtained
after stent-graft deployment shows normal diameter of thoracic aorta proximal
and distal to stent-graft.
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Fig. 6B. —72-year-old man (patient 10) with penetrating ulcer of
thoracic aorta. Posterior oblique volume-rendering reconstruction obtained 6
months after intervention shows formation of aneurysms (arrows)
proximal and distal to stent-graft. Dilatation of proximal and distal ends of
stent-graft caused by pressure of aneurysms is evident.
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Copyright © 2002 by the American Roentgen Ray Society.
