Type:
Educational Exhibit
Keywords:
Interventional vascular, Abdomen, Arteries / Aorta, CT, CT-Angiography, Catheter arteriography, Arterial access, Education, Technical aspects, Fistula, Aneurysms
Authors:
A. Paladini, G. Pizzi, G. E. Vallati, C. Di Stasi, E. M. Amodeo; Rome/IT
DOI:
10.1594/ecr2018/C-0038
Findings and procedure details
Despite being an emergency,
in the 75% of cases FAD does not have a clinically evident beginning.
As a consequence,
the correct use of imaging is basic not only from a diagnostical point of view,
but also for clinical management.
Melena and hematemesis could be very important clinical signs which can guide the radiologist to the differential diagnosis.
CT-angiography is the gold standard in case of FAD with a sensibility of 94% and specificity of 85%.
First of all,
Radiologist should understand not only which kind of FAD it is (primary or secondary),
but also which is the correct localization of the problem so as to guide the surgeon or the Interventional radiologist towards the right treatment.
•Vascular Localization:
Abdominal Aorta,
Iliac arteries,
Celiac trunk
•Enteric Localization:
Esophagus (rare),
Duodeno (80-85%), Appendix or sigma (rare)
70% of Patients survive at least 6 h and 50% of them,
survive 24 h after hemorragic start.
Radiologist should think to this condition in case of anamnesis of aortic intervention.
To get a diagnosis,
Radiologist could use:
•EGDS: Sensitivity 30%
Angiography: Sensitivity 30%
•Angio-CT: Sensitivity 30-65%; Sensibility 94% and specificity 85% in case of infection (presence of fluid,
gas and attenuation of peri-graft tissue,
intestinal wall thickening)
• Emergency laparotomy only in case of severe hemodynamic instability