Learning objectives
To review the main aortic repair techniques.
To define the normal postoperative appearance of thoracic and abdominal aorta.
To help avoid imaging pitfalls.
To review the most common complications.
Background
Aortic interventions can be divided mainly in three categories:
open repair surgery
endovascular repair
hybrid procedures.
Open repair surgery
Open repair surgery involves replacement of the aorta with a graft usually composed of synthetic polyester.Graft can be placed either through an interposition graft or an inclusion graft (Fig. 1 Fig. 2).
The most common use of open repair surgery is for treatment of ascending aortic diseases, as this segment is not usually suited for endovascular treatment.
Open repair surgery of the ascending aorta usually includes:...
Findings and procedure details
CTA protocol usually involves three phases:
unenhanced phase, contrast enhanced arterial and delayed phases.
Unenhanced images are very helpful in avoiding imaging pitfalls.
Contrast enhanced arterial phase are essential in the assessment of vascular anatomy.
Contrast enhanced delayed phase (180 s) may be crucial for detection of slow flow endoleaks.
ECG gating is mandatory in the evaluation of aortic root and coronary artery ostia.
Contrast material should be administrated at a high flow rate (4-5 ml/sec).
Aortic grafts have no distinctive imaging features. They usually...
Conclusion
Knowledge of CTA appearance of open, hybrid, endovascular procedures is essential to the proper evaluation and interpretation of post-operative aorta.
Personal information and conflict of interest
M. Finazzo; Palermo/IT - nothing to disclose C. Duranti; Palermo/IT - nothing to disclose G. Filippone; Palermo/IT - nothing to disclose F. Finazzo; Palermo/IT - nothing to disclose G. Peritore; Palermo/IT - nothing to disclose D. Messana; Palermo/IT - nothing to disclose
References
Pamela T. Johnson, Frank M. Corl, James H. Black, Elliot K. Fishman. The Elephant Trunk Procedure for Aortic Aneurysm Repair: An Illustrated Guide to Surgical Technique With CT Correlation. AJR 2011; 197:W1052–W1059.
Baskaran Sundaram,Leslie E. Quint, Himanshu J. Patel, G. Michael Deeb. CT Findings Following Thoracic Aortic Surgery. RadioGraphics 2007; 27:1583–1594.
H. Rousseau, V. Chabbert, M.A. Maracher, O. El Aassar , J. Auriol, P. Massabuau, R. Moreno. The Importance of Imaging Assessment Before Endovascular Repair of Thoracic Aorta. Eur J Vasc Endovasc Surg (2009) 38,...