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Helical CT Angiography of Stent-Grafts in Abdominal Aortic Aneurysms: Morphologic Changes and Complications¹

¹ From the Departments of Radiology (M.T., K.A.H., J.T., R.G., D.H.S.) and Vascular Surgery (K.T.), Karl-Franzens Medical School and University Hospital, Graz, Austria. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received March 30, 1999; revision requested April 20 and received June 9; accepted June 9. Address reprint requests to M.T., Department of Radiology, Section of Thoracic Imaging, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5105.

Transfemoral placement of an endovascular stent-graft is increasingly being used as an alternative to surgical repair in the treatment of abdominal aortic aneurysm, especially in high-risk patients. However, complications frequently occur after stent-graft placement. Helical computed tomographic (CT) angiography is a fast, minimally invasive procedure that is quickly becoming the imaging modality of choice for assessment of these complications. Thirty-nine patients who were treated for abdominal aortic aneurysm with stent-graft placement underwent helical CT angiography at routinely scheduled follow-up intervals or whenever complications were suspected. The resulting images were evaluated for the presence, extent, and origin of endovascular leaks. In addition, the position, shape, and patency of the stent-grafts were assessed. Findings included both graft-related (n = 4) and non–graft-related (n = 3) leaks, thrombosis of a graft limb (n = 3), distal migration of the stent-graft (n = 5), angulation of bifurcated stent-grafts distal to the main graft (n = 6), shrinkage of the abdominal aortic aneurysm (n = 7), enlargement of the aneurysm with secondary graft-related leaks (n = 2), and an aortoduodenal fistula (n = 1). Helical CT angiography can depict complications that develop after treatment of abdominal aortic aneurysms with endovascular stent-grafts. Long-term follow-up is required to determine the full spectrum and frequency of complications that may develop after initially successful repair.

Index Terms: Aneurysm, aortic, 981.73 • Aneurysm, CT, 981.12915, 981.12916 • Aneurysm, therapy, 981.1268 • Computed tomography, angiography, 981.12915, 981.12916 • Stents and prostheses, 981.1268

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