Neoaortoiliac Reconstructions Using Femoropopliteal Veins: MDCT Angiography Findings
Jorge E. Lopera1,2,
Clayton K. Trimmer1,
Shellie Josephs1,
Bart Dolmatch1,
R. James Valentine3 and
G. Patrick Clagett3
1 Department of Radiology, UT Southwestern Medical Center, Dallas, TX.
2 Present address: Department of Radiology, UT Health Science Center at San
Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900.
3 Department of Vascular Surgery, UT Southwestern Medical Center, Dallas,
TX.
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Fig. 2 —68-year-old man with history of neoaortoiliac system
procedure for infected aortobifemoral graft and left nephrectomy.
Volume-rendered semitransparent coronal projection shows proximal anastomosis
with aorta (yellow arrow). Two limbs of superficial femoropopliteal
veins (white arrows) extend into distal anastomoses with common
femoral artery (arrowheads). Left kidney is absent. Note
characteristic appearance of native veins in limbs of bypass.
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Fig. 3 —77-year-old man who underwent neoaortoiliac system procedure
for infection of right aortofemoral and left aortoiliac grafts.
Volume-rendered coronal image shows right aortofemoral neoaortoiliac system
bypass (white arrows) with left aortoiliac limb (yellow
arrow). Left kidney had severe hydronephrosis with delayed excretion of
contrast material.
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Fig. 4 —60-year-old woman after neoaortoiliac system procedure for
occluded and infected aortobifemoral graft. Volume-rendered coronal image
shows unilateral left aortofemoral bypass with end-to-end anastomosis between
left limb of neoaortoiliac system and aorta (arrow) and shows
left-to-right femorofemoral crossover bypass.
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Fig. 5 —56-year-old man who underwent neoaortoiliac system procedure
with right femoropopliteal bypass. Volume-rendered right anterior oblique
image shows left aortofemoral neoaortoiliac system bypass with left-to-right
femorofemoral crossover bypass. Note proximal end-to-side anastomosis with
aorta (straight arrow). Patient also has patent right femoropopliteal
bypass (curved arrows).
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Fig. 6 —57-year-old man who had history of infected aortobifemoral
bypass graft with occlusion of left limb that required previous amputation.
Volume-rendered coronal image shows unilateral right aortofemoral
neoaortoiliac system or hemineoaortoiliac system.
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Fig. 7 —62-year-old woman who underwent neoaortoiliac system
procedure for thrombosed and infected aortobifemoral graft. Volume-rendered
coronal image shows neoaortoiliac system with right aortofemoral bypass
(arrows). Left limb is anastomosed in end-to-side fashion to right
limb of bypass (arrowheads).
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Fig. 8A —65-year-old man who underwent neoaortoiliac system procedure
for infected aortobifemoral graft. Axial CT image after administration of IV
contrast material shows popliteal veins distended with clots at stumps
(arrows) after superficial femoropopliteal vein harvesting.
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Fig. 8B —65-year-old man who underwent neoaortoiliac system procedure
for infected aortobifemoral graft. Axial CT image obtained at more superior
level than A, at area of vein harvesting, shows that superficial
femoropopliteal veins are absent.
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Fig. 9A —48-year-old woman with severe aortoiliac disease and
bilateral lower extremity claudication. Volume-rendered coronal projection
before neoaortoiliac system procedure shows severe aortoiliac disease with
diffuse stenosis of both iliac systems (arrows) with patent right
femoropopliteal bypass (arrowheads). Left distal superior femoral
artery and popliteal arteries are occluded. Patient underwent neoaortoiliac
system procedure, but it was complicated by thrombosis of left limb of
neoaortoiliac system. Leg amputation was performed 1 week after procedure.
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Fig. 9B —48-year-old woman with severe aortoiliac disease and
bilateral lower extremity claudication. Volume-rendered coronal image shows
patent right limb of neoaortoiliac system and occluded left limb with proximal
stump (arrow). Note also thrombosis of right femoropopliteal
bypass.
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Fig. 10A —60-year-old woman who underwent neoaortoiliac system
procedure for infected aortobifemoral graft placed 1 year earlier presenting
with acute ischemia of right leg lower extremity. Axial CT image shows partial
thrombosis of right limb of neoaortoiliac system (arrow).
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Fig. 10B —60-year-old woman who underwent neoaortoiliac system
procedure for infected aortobifemoral graft placed 1 year earlier presenting
with acute ischemia of right leg lower extremity. Volume-rendered right
anterior oblique projection shows right limb stenosis (arrow);
thrombus is not shown in 3D reconstruction.
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Fig. 10C —60-year-old woman who underwent neoaortoiliac system
procedure for infected aortobifemoral graft placed 1 year earlier presenting
with acute ischemia of right leg lower extremity. Volume-rendered posterior
view of lower legs shows abrupt cutoff of right anterior and posterior tibial
arteries related to distal embolization (arrowheads). Patient was
treated with anticoagulation therapy and symptoms resolved thereafter.
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Fig. 11A —58-year-old woman who underwent neoaortoiliac system
procedure 3 years before presenting with bilateral lower extremity
claudication. Duplex sonogram shows tapering of abdominal aorta at proximal
anastomosis of neoaortoiliac system (arrow). Note high velocities of
3.92 m/s at area of stenosis.
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Fig. 11B —58-year-old woman who underwent neoaortoiliac system
procedure 3 years before presenting with bilateral lower extremity
claudication. Axial image shows severe decrease in caliber at area of stenosis
(arrow).
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Fig. 11C —58-year-old woman who underwent neoaortoiliac system
procedure 3 years before presenting with bilateral lower extremity
claudication. Volume-rendered oblique projection shows severe stenosis of
proximal anastomosis with infrarenal aorta (arrow).
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Fig. 11D —58-year-old woman who underwent neoaortoiliac system
procedure 3 years before presenting with bilateral lower extremity
claudication. Volume-rendered coronal image shows tube graft composed of
synthetic polyester (Dacron, DuPont) extending from descending thoracic aorta
into distal body of vein graft (arrows) and bypassing stenosis of
proximal anastomosis of neoaortoiliac system.
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Fig. 12A —87-year-old woman who had undergone neoaortoiliac system
procedure 5 months earlier presenting with severe left lower extremity
claudication. Axial CT image (A) and volume-rendered coronal image
(B) show severe stenosis of left limb of graft at end-to-side proximal
anastomosis (arrows). Patient underwent right-to-left femoral
crossover bypass graft with greater saphenous vein.
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Fig. 12B —87-year-old woman who had undergone neoaortoiliac system
procedure 5 months earlier presenting with severe left lower extremity
claudication. Axial CT image (A) and volume-rendered coronal image
(B) show severe stenosis of left limb of graft at end-to-side proximal
anastomosis (arrows). Patient underwent right-to-left femoral
crossover bypass graft with greater saphenous vein.
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Fig. 12C —87-year-old woman who had undergone neoaortoiliac system
procedure 5 months earlier presenting with severe left lower extremity
claudication. Volume-rendered coronal image after surgical revision shows that
left limb is now occluded. Severe stenosis is seen in midportion of
femorofemoral bypass (arrow). Additional revision with angioplasty
and stent placement was later performed.
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Fig. 13A —53-year-old woman who had undergone neoaortoiliac system
procedure due to aortoiliac occlusive disease 1 year earlier presenting with
limiting right leg claudication. Routine sonography shows very high velocities
in right limb of neoaortoiliac system. Axial (A) and volume-rendered
coronal (B) images show two high-grade stenoses in right limb of
neoaortoiliac system (arrows). Native aorta (arrowhead,
A) is occluded. Patient was treated with angioplasty of right limb
stenosis, which resulted in vessel rupture; stent-graft was then placed.
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Fig. 13B —53-year-old woman who had undergone neoaortoiliac system
procedure due to aortoiliac occlusive disease 1 year earlier presenting with
limiting right leg claudication. Routine sonography shows very high velocities
in right limb of neoaortoiliac system. Axial (A) and volume-rendered
coronal (B) images show two high-grade stenoses in right limb of
neoaortoiliac system (arrows). Native aorta (arrowhead,
A) is occluded. Patient was treated with angioplasty of right limb
stenosis, which resulted in vessel rupture; stent-graft was then placed.
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Fig. 13C —53-year-old woman who had undergone neoaortoiliac system
procedure due to aortoiliac occlusive disease 1 year earlier presenting with
limiting right leg claudication. Routine sonography shows very high velocities
in right limb of neoaortoiliac system. Volume-rendered coronal image after
endovascular treatment shows metallic stent (arrows). Only surface of
stent is visualized in 3D reconstruction.
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Fig. 13D —53-year-old woman who had undergone neoaortoiliac system
procedure due to aortoiliac occlusive disease 1 year earlier presenting with
limiting right leg claudication. Routine sonography shows very high velocities
in right limb of neoaortoiliac system. Maximal-intensity-projection
reconstruction image with vessel analysis shows that metallic stent is widely
patent.
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Fig. 14 —65-year-old woman who had undergone neoaortoiliac system
procedure for infected aortobifemoral graft presenting with left leg
claudication. Volume-rendered oblique image shows severe stenosis of left
distal limb of neoaortoiliac system (arrow) and mild to moderate
stenosis in distal right limb (arrowhead). Retrograde filling of
native right iliac system (I) is present. Right superficial femoral artery is
occluded in short segment. Patient underwent patch angioplasty with greater
saphenous vein. Lesion was produced by neointimal hyperplasia related to
retained valve cusp.
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Fig. 15 —Neoaortoiliac system procedure was performed 6 years earlier
in 45-year-old man for severe aortoiliac disease. Volume-rendered coronal
projection shows diffuse aneurysmal dilatation of right aortofemoral bypass
(arrows). Right-to-left femorofemoral bypass has normal caliber.
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Copyright © 2008 by the American Roentgen Ray Society.
