HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tillich, M. Articles by Szolar, D. H. Search for Related Content PubMed PubMed Citation Articles by Tillich, M. Articles by Szolar, D. H. Related Collections Vascular and/or Interventional Radiology Computed Tomography

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.

View larger version (145K): [in a new window]   Figure 1a.   Basic designs of nitinol stents covered with woven Dacron (polyethylene terephthalate fiber) graft material. (a) Photograph shows a tube stent-graft. The stent frame is covered with a thin-woven polyester fabric. The leading part of the stent-graft is uncovered (arrows). (b) Photograph shows a bifurcated stent-graft. The device has two components, which are inserted separately and mated in place: The main graft has a single limb, and a second limb is inserted contralaterally and implanted in the trailing end of the main graft (arrows).

View larger version (131K): [in a new window]   Figure 1b.   Basic designs of nitinol stents covered with woven Dacron (polyethylene terephthalate fiber) graft material. (a) Photograph shows a tube stent-graft. The stent frame is covered with a thin-woven polyester fabric. The leading part of the stent-graft is uncovered (arrows). (b) Photograph shows a bifurcated stent-graft. The device has two components, which are inserted separately and mated in place: The main graft has a single limb, and a second limb is inserted contralaterally and implanted in the trailing end of the main graft (arrows).

View larger version (147K): [in a new window]   Figure 2.   Primary non-graft-related leak after therapy with a bifurcated graft. Axial helical CT scan obtained 1 week after therapy shows a primary non-graft-related leak (arrow) caused by collateral flow into the aneurysm sac from a patent inferior mesenteric artery (arrowheads).

View larger version (154K): [in a new window]   Figure 3.   Primary non-graft-related leak after therapy with a bifurcated graft. Axial helical CT scan obtained 1 week after therapy shows a primary non-graft-related leak (arrows) caused by persistent flow into the aneurysm sac from patent lumbar arteries (arrowheads).

View larger version (115K): [in a new window]   Figure 4a.   Primary graft-related leak after therapy with a bifurcated graft. (a) Axial helical CT scan obtained 1 week after therapy shows a primary graft-related leak at the medial distal aspect of the left graft limb (arrowheads). (b) Axial helical CT scan obtained at the proximal aspect of the graft limbs shows the leak anterior to the limbs (arrows). (c) Sagittal maximum intensity projection (MIP) image shows proximal extension of the leak (arrows).

View larger version (114K): [in a new window]   Figure 4b.   Primary graft-related leak after therapy with a bifurcated graft. (a) Axial helical CT scan obtained 1 week after therapy shows a primary graft-related leak at the medial distal aspect of the left graft limb (arrowheads). (b) Axial helical CT scan obtained at the proximal aspect of the graft limbs shows the leak anterior to the limbs (arrows). (c) Sagittal maximum intensity projection (MIP) image shows proximal extension of the leak (arrows).

View larger version (103K): [in a new window]   Figure 4c.   Primary graft-related leak after therapy with a bifurcated graft. (a) Axial helical CT scan obtained 1 week after therapy shows a primary graft-related leak at the medial distal aspect of the left graft limb (arrowheads). (b) Axial helical CT scan obtained at the proximal aspect of the graft limbs shows the leak anterior to the limbs (arrows). (c) Sagittal maximum intensity projection (MIP) image shows proximal extension of the leak (arrows).

View larger version (129K): [in a new window]   Figure 5a.   Primary graft-related leak after therapy with a bifurcated graft. (a) Axial helical CT scan obtained 1 week after therapy shows a primary graft-related leak (arrow) caused by an incomplete seal at the junction of the main graft and the secondary implanted limb (arrowheads). (b) Axial helical CT scan obtained at the level of the graft limbs shows a leak in the posterior aspect of the aneurysm sac (arrows).

View larger version (130K): [in a new window]   Figure 5b.   Primary graft-related leak after therapy with a bifurcated graft. (a) Axial helical CT scan obtained 1 week after therapy shows a primary graft-related leak (arrow) caused by an incomplete seal at the junction of the main graft and the secondary implanted limb (arrowheads). (b) Axial helical CT scan obtained at the level of the graft limbs shows a leak in the posterior aspect of the aneurysm sac (arrows).

View larger version (89K): [in a new window]   Figure 6.   Secondary graft-related leak after therapy with a bifurcated graft. Axial helical CT scan obtained 12 months after therapy shows a secondary graft-related leak (arrowhead) at the junction of the main graft and the secondary implanted right limb (white arrow) caused by disconnection of the graft limb (black arrow).

View larger version (97K): [in a new window]   Figure 7a.   Secondary graft-related leak after therapy with a bifurcated graft. (a) Axial helical CT scan obtained 18 months after therapy shows a secondary graft-related leak distal to the right graft limb (arrow). (b) Sagittal MIP image shows that the distal aspect of the right graft limb has migrated proximally into the aneurysm sac (arrow) and caused the leak.

View larger version (81K): [in a new window]   Figure 7b.   Secondary graft-related leak after therapy with a bifurcated graft. (a) Axial helical CT scan obtained 18 months after therapy shows a secondary graft-related leak distal to the right graft limb (arrow). (b) Sagittal MIP image shows that the distal aspect of the right graft limb has migrated proximally into the aneurysm sac (arrow) and caused the leak.

View larger version (89K): [in a new window]   Figure 8a.   Secondary graft-related leak after therapy with a tube graft. (a) Sagittal MIP image obtained 1 week after therapy shows a tube graft with normal position and shape. (b) Sagittal MIP image obtained 12 months after therapy shows a secondary graft-related leak at the anterior distal aspect of the tube graft. The distal wire-form attachment (arrow) has become detached from the aortic wall due to hemodynamic forces similar to those that may cause formation of an anastomotic aneurysm.

View larger version (90K): [in a new window]   Figure 8b.   Secondary graft-related leak after therapy with a tube graft. (a) Sagittal MIP image obtained 1 week after therapy shows a tube graft with normal position and shape. (b) Sagittal MIP image obtained 12 months after therapy shows a secondary graft-related leak at the anterior distal aspect of the tube graft. The distal wire-form attachment (arrow) has become detached from the aortic wall due to hemodynamic forces similar to those that may cause formation of an anastomotic aneurysm.

View larger version (93K): [in a new window]   Figure 9a.   Stent-graft migration after therapy with a bifurcated graft. (a) Coronal oblique MIP image obtained 1 week after therapy shows the proximal end of the graft below the origin of the right renal artery (arrow). (b) Coronal oblique MIP image obtained 18 months after therapy shows distal migration of the body of the bifurcated graft (arrow) and superior migration of the right graft limb without evidence of an endovascular leak.

View larger version (83K): [in a new window]   Figure 9b.   Stent-graft migration after therapy with a bifurcated graft. (a) Coronal oblique MIP image obtained 1 week after therapy shows the proximal end of the graft below the origin of the right renal artery (arrow). (b) Coronal oblique MIP image obtained 18 months after therapy shows distal migration of the body of the bifurcated graft (arrow) and superior migration of the right graft limb without evidence of an endovascular leak.

View larger version (86K): [in a new window]   Figure 10a.   Stent-graft angulation after therapy with a bifurcated graft. (a) Sagittal MIP image obtained 1 week after therapy shows a stent-graft with normal position and shape. (b) Sagittal MIP image obtained 12 months after therapy shows severe angulation of the stent-graft distal to the main graft and associated distal migration of the proximal end.

View larger version (76K): [in a new window]   Figure 10b.   Stent-graft angulation after therapy with a bifurcated graft. (a) Sagittal MIP image obtained 1 week after therapy shows a stent-graft with normal position and shape. (b) Sagittal MIP image obtained 12 months after therapy shows severe angulation of the stent-graft distal to the main graft and associated distal migration of the proximal end.

View larger version (119K): [in a new window]   Figure 11a.   Stent-graft thrombosis after therapy with a bifurcated graft. (a) Axial helical CT scan of the midgraft region obtained 5 months after therapy shows a crescent-shaped, parietal thrombus adjacent to the left wall of the stent-graft (arrowheads) extending distally into the left graft limb. (b) Photograph of the surgical specimen shows the thrombus adjacent to the left wall of the stent-graft (arrowheads). (c) Axial helical CT scan obtained at the level of the graft limbs shows complete thrombosis of the left graft limb (arrow).

View larger version (110K): [in a new window]   Figure 11b.   Stent-graft thrombosis after therapy with a bifurcated graft. (a) Axial helical CT scan of the midgraft region obtained 5 months after therapy shows a crescent-shaped, parietal thrombus adjacent to the left wall of the stent-graft (arrowheads) extending distally into the left graft limb. (b) Photograph of the surgical specimen shows the thrombus adjacent to the left wall of the stent-graft (arrowheads). (c) Axial helical CT scan obtained at the level of the graft limbs shows complete thrombosis of the left graft limb (arrow).

View larger version (117K): [in a new window]   Figure 11c.   Stent-graft thrombosis after therapy with a bifurcated graft. (a) Axial helical CT scan of the midgraft region obtained 5 months after therapy shows a crescent-shaped, parietal thrombus adjacent to the left wall of the stent-graft (arrowheads) extending distally into the left graft limb. (b) Photograph of the surgical specimen shows the thrombus adjacent to the left wall of the stent-graft (arrowheads). (c) Axial helical CT scan obtained at the level of the graft limbs shows complete thrombosis of the left graft limb (arrow).

View larger version (135K): [in a new window]   Figure 12a.   Aortoduodenal fistula after therapy with a bifurcated graft. (a) Axial helical CT scan of the proximal graft region obtained 21 months after therapy shows deformity of the proximal end of the graft. The eccentric deformity of the aneurysm sac at the anterior lateral aspect cannot be distinguished from the posterior wall of the ascending part of the collapsed duodenum (arrows). (b) Intraoperative photograph taken during removal of the stent-graft reveals fragmentation of the proximal end of the stent-graft (arrows) and an aortoduodenal fistula. These findings were not detected at helical CT. (c) Photograph provides close-up view of the fragmented proximal end of the stent-graft.

View larger version (171K): [in a new window]   Figure 12b.   Aortoduodenal fistula after therapy with a bifurcated graft. (a) Axial helical CT scan of the proximal graft region obtained 21 months after therapy shows deformity of the proximal end of the graft. The eccentric deformity of the aneurysm sac at the anterior lateral aspect cannot be distinguished from the posterior wall of the ascending part of the collapsed duodenum (arrows). (b) Intraoperative photograph taken during removal of the stent-graft reveals fragmentation of the proximal end of the stent-graft (arrows) and an aortoduodenal fistula. These findings were not detected at helical CT. (c) Photograph provides close-up view of the fragmented proximal end of the stent-graft.

View larger version (140K): [in a new window]   Figure 12c.   Aortoduodenal fistula after therapy with a bifurcated graft. (a) Axial helical CT scan of the proximal graft region obtained 21 months after therapy shows deformity of the proximal end of the graft. The eccentric deformity of the aneurysm sac at the anterior lateral aspect cannot be distinguished from the posterior wall of the ascending part of the collapsed duodenum (arrows). (b) Intraoperative photograph taken during removal of the stent-graft reveals fragmentation of the proximal end of the stent-graft (arrows) and an aortoduodenal fistula. These findings were not detected at helical CT. (c) Photograph provides close-up view of the fragmented proximal end of the stent-graft.