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 Mita, T. Articles by Matsuzaki, M. Search for Related Content PubMed PubMed Citation Articles by Mita, T. Articles by Matsuzaki, M. Related Collections Vascular and/or Interventional Radiology

Complications of Endovascular Repair for Thoracic and Abdominal Aortic Aneurysm: An Imaging Spectrum¹

¹ From the Department of Radiology (T.M., T.A., N.M., M.F.), First Department of Surgery (N.Z., K.E.), and Second Department of Internal Medicine (M.M.), Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan. Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received March 3, 2000; revision requested March 29 and received May 9; accepted May 12. Address correspondence to T.M. (e-mail: mitafumi@mx51.tiki.ne.jp).

View larger version (93K): [in a new window]   Figure 1a.   Proximal endoleak due to a short proximal neck of the aneurysm in a 72-year-old man with a distal arch aneurysm. (a) Preprocedural multiplanar reconstruction image (oblique sagittal view) shows a distal arch aneurysm with a short proximal neck. (b) Follow-up multiplanar reconstruction image (sagittal view) obtained 1 week after stent-graft implantation show proximal endoleak (arrows).

View larger version (89K): [in a new window]   Figure 1b.   Proximal endoleak due to a short proximal neck of the aneurysm in a 72-year-old man with a distal arch aneurysm. (a) Preprocedural multiplanar reconstruction image (oblique sagittal view) shows a distal arch aneurysm with a short proximal neck. (b) Follow-up multiplanar reconstruction image (sagittal view) obtained 1 week after stent-graft implantation show proximal endoleak (arrows).

View larger version (92K): [in a new window]   Figure 2a.   Persistent proximal endoleak due to a tortuous proximal neck of the aneurysm in a 68-year-old woman with an infrarenal abdominal aortic aneurysm. (a, b) Curved-planar reconstruction (a) and sagittal multiplanar reconstruction (b) images obtained 12 months after stent-graft implantation show proximal endoleak (arrows). The angle of the proximal neck of the aneurysm is acute. (c) Magnified image of b clearly demonstrates insufficient attachment of the proximal end of the stent-graft to the aortic wall (arrows).

View larger version (91K): [in a new window]   Figure 2b.   Persistent proximal endoleak due to a tortuous proximal neck of the aneurysm in a 68-year-old woman with an infrarenal abdominal aortic aneurysm. (a, b) Curved-planar reconstruction (a) and sagittal multiplanar reconstruction (b) images obtained 12 months after stent-graft implantation show proximal endoleak (arrows). The angle of the proximal neck of the aneurysm is acute. (c) Magnified image of b clearly demonstrates insufficient attachment of the proximal end of the stent-graft to the aortic wall (arrows).

View larger version (82K): [in a new window]   Figure 2c.   Persistent proximal endoleak due to a tortuous proximal neck of the aneurysm in a 68-year-old woman with an infrarenal abdominal aortic aneurysm. (a, b) Curved-planar reconstruction (a) and sagittal multiplanar reconstruction (b) images obtained 12 months after stent-graft implantation show proximal endoleak (arrows). The angle of the proximal neck of the aneurysm is acute. (c) Magnified image of b clearly demonstrates insufficient attachment of the proximal end of the stent-graft to the aortic wall (arrows).

View larger version (105K): [in a new window]   Figure 3a.   Distal endoleak developed 3 months after tapered stent-graft implantation from the aorta to the left iliac artery combined with right common iliac artery occlusion and ilioiliac bypass grafting in an 83-year-old man with an infrarenal abdominal aortic aneurysm. (a) Preprocedural curved-planar reconstruction image shows an infrarenal aortic aneurysm extending into the left common iliac artery. (b) Curved-planar reconstruction image obtained 1 week after stent-graft implantation shows no endoleak, but the distal end of the stent-graft is within the mural thrombus of the aneurysm (small arrow), and the internal iliac artery is patent (arrowhead). Occlusion stent-graft is placed in the right common iliac artery (large arrow). (c) Curved-planar reconstruction image obtained 3 months after stent-graft implantation reveals development of distal endoleak (arrows).

View larger version (102K): [in a new window]   Figure 3b.   Distal endoleak developed 3 months after tapered stent-graft implantation from the aorta to the left iliac artery combined with right common iliac artery occlusion and ilioiliac bypass grafting in an 83-year-old man with an infrarenal abdominal aortic aneurysm. (a) Preprocedural curved-planar reconstruction image shows an infrarenal aortic aneurysm extending into the left common iliac artery. (b) Curved-planar reconstruction image obtained 1 week after stent-graft implantation shows no endoleak, but the distal end of the stent-graft is within the mural thrombus of the aneurysm (small arrow), and the internal iliac artery is patent (arrowhead). Occlusion stent-graft is placed in the right common iliac artery (large arrow). (c) Curved-planar reconstruction image obtained 3 months after stent-graft implantation reveals development of distal endoleak (arrows).

View larger version (95K): [in a new window]   Figure 3c.   Distal endoleak developed 3 months after tapered stent-graft implantation from the aorta to the left iliac artery combined with right common iliac artery occlusion and ilioiliac bypass grafting in an 83-year-old man with an infrarenal abdominal aortic aneurysm. (a) Preprocedural curved-planar reconstruction image shows an infrarenal aortic aneurysm extending into the left common iliac artery. (b) Curved-planar reconstruction image obtained 1 week after stent-graft implantation shows no endoleak, but the distal end of the stent-graft is within the mural thrombus of the aneurysm (small arrow), and the internal iliac artery is patent (arrowhead). Occlusion stent-graft is placed in the right common iliac artery (large arrow). (c) Curved-planar reconstruction image obtained 3 months after stent-graft implantation reveals development of distal endoleak (arrows).

View larger version (159K): [in a new window]   Figure 4a.   Graft thrombosis after stent-graft implantation in a 79-year-old man with an infrarenal aortic aneurysm. (a) Axial CT image obtained 2 weeks after stent-graft implantation shows a 6.5-mm-wide, crescent-shaped thrombus within the stent-graft. (b) Axial CT image obtained 3 months after the procedure reveals that the thrombus has shrunk without any treatment.

View larger version (156K): [in a new window]   Figure 4b.   Graft thrombosis after stent-graft implantation in a 79-year-old man with an infrarenal aortic aneurysm. (a) Axial CT image obtained 2 weeks after stent-graft implantation shows a 6.5-mm-wide, crescent-shaped thrombus within the stent-graft. (b) Axial CT image obtained 3 months after the procedure reveals that the thrombus has shrunk without any treatment.

View larger version (131K): [in a new window]   Figure 5a.   Graft kinking after stent-graft implantation in a 74-year-old man with an infrarenal abdominal aortic aneurysm. (a) Sagittal multiplanar reconstruction image obtained 7 months after stent-graft implantation shows no endoleak or graft kinking. The proximal end of the aneurysm is at the level of the upper end (arrow) of the second lumbar spine (L2). (b) Sagittal multiplanar reconstruction image obtained 12 months after the procedure shows an apparent decrease in diameter of the aneurysm and development of graft kinking. A decrease in length of the aneurysm is also indicated by caudal deviation of the proximal end of the aneurysm (arrow).

View larger version (132K): [in a new window]   Figure 5b.   Graft kinking after stent-graft implantation in a 74-year-old man with an infrarenal abdominal aortic aneurysm. (a) Sagittal multiplanar reconstruction image obtained 7 months after stent-graft implantation shows no endoleak or graft kinking. The proximal end of the aneurysm is at the level of the upper end (arrow) of the second lumbar spine (L2). (b) Sagittal multiplanar reconstruction image obtained 12 months after the procedure shows an apparent decrease in diameter of the aneurysm and development of graft kinking. A decrease in length of the aneurysm is also indicated by caudal deviation of the proximal end of the aneurysm (arrow).

View larger version (123K): [in a new window]   Figure 6a.   Graft kinking after straight stent-graft implantation in a 77-year-old man with an infrarenal aortic aneurysm. (a) Curved-planar reconstruction image obtained 6 days after implantation shows no endoleak or graft kinking. (b) Curved-planar reconstruction image obtained 3 months after the procedure shows a kink and caudal displacement of the proximal end of the stent-graft. No change is seen in the maximum diameter of the aneurysm.

View larger version (102K): [in a new window]   Figure 6b.   Graft kinking after straight stent-graft implantation in a 77-year-old man with an infrarenal aortic aneurysm. (a) Curved-planar reconstruction image obtained 6 days after implantation shows no endoleak or graft kinking. (b) Curved-planar reconstruction image obtained 3 months after the procedure shows a kink and caudal displacement of the proximal end of the stent-graft. No change is seen in the maximum diameter of the aneurysm.

View larger version (159K): [in a new window]   Figure 7a.   Pseudoaneurysm caused by graft infection in an 82-year-old man with an infrarenal aortic aneurysm. (a) Abdominal radiograph obtained 2 weeks after tapered stent-graft implantation from the aorta to the right iliac artery combined with left common iliac artery occlusion, coil embolization of the left internal iliac artery, and ilioiliac bypass grafting reveals the occluded stent-graft placed at the narrowing of the left common iliac artery as it runs peripherally (arrows). (b) Digital subtraction angiogram obtained 2 weeks after the procedure shows no abnormal findings. (c) Axial CT image obtained 2 weeks after the procedure shows no abnormal findings at the distal end of the occluded stent-graft. (d) Axial CT scan obtained 2 months after the procedure shows development of a soft-tissue-attenuating area (arrows) around the distal end of the occluded stent-graft (arrowheads). The patient had fever, left inguinal swelling, and tenderness. (e) Abdominal radiograph obtained 2 months after the procedure shows expansion of the distal end of the occluded stent-graft (arrows). (f) Digital subtraction angiogram obtained 2 months after the procedure reveals pseudoaneurysmal formation around the distal end of the occluded stent-graft (arrows). Infection of the occluded stent-graft and pseudoaneurysm were confirmed in an emergent surgery when the distal end of the occluded stent-graft was seen to protrude from the external iliac artery.

View larger version (181K): [in a new window]   Figure 7b.   Pseudoaneurysm caused by graft infection in an 82-year-old man with an infrarenal aortic aneurysm. (a) Abdominal radiograph obtained 2 weeks after tapered stent-graft implantation from the aorta to the right iliac artery combined with left common iliac artery occlusion, coil embolization of the left internal iliac artery, and ilioiliac bypass grafting reveals the occluded stent-graft placed at the narrowing of the left common iliac artery as it runs peripherally (arrows). (b) Digital subtraction angiogram obtained 2 weeks after the procedure shows no abnormal findings. (c) Axial CT image obtained 2 weeks after the procedure shows no abnormal findings at the distal end of the occluded stent-graft. (d) Axial CT scan obtained 2 months after the procedure shows development of a soft-tissue-attenuating area (arrows) around the distal end of the occluded stent-graft (arrowheads). The patient had fever, left inguinal swelling, and tenderness. (e) Abdominal radiograph obtained 2 months after the procedure shows expansion of the distal end of the occluded stent-graft (arrows). (f) Digital subtraction angiogram obtained 2 months after the procedure reveals pseudoaneurysmal formation around the distal end of the occluded stent-graft (arrows). Infection of the occluded stent-graft and pseudoaneurysm were confirmed in an emergent surgery when the distal end of the occluded stent-graft was seen to protrude from the external iliac artery.

View larger version (144K): [in a new window]   Figure 7c.   Pseudoaneurysm caused by graft infection in an 82-year-old man with an infrarenal aortic aneurysm. (a) Abdominal radiograph obtained 2 weeks after tapered stent-graft implantation from the aorta to the right iliac artery combined with left common iliac artery occlusion, coil embolization of the left internal iliac artery, and ilioiliac bypass grafting reveals the occluded stent-graft placed at the narrowing of the left common iliac artery as it runs peripherally (arrows). (b) Digital subtraction angiogram obtained 2 weeks after the procedure shows no abnormal findings. (c) Axial CT image obtained 2 weeks after the procedure shows no abnormal findings at the distal end of the occluded stent-graft. (d) Axial CT scan obtained 2 months after the procedure shows development of a soft-tissue-attenuating area (arrows) around the distal end of the occluded stent-graft (arrowheads). The patient had fever, left inguinal swelling, and tenderness. (e) Abdominal radiograph obtained 2 months after the procedure shows expansion of the distal end of the occluded stent-graft (arrows). (f) Digital subtraction angiogram obtained 2 months after the procedure reveals pseudoaneurysmal formation around the distal end of the occluded stent-graft (arrows). Infection of the occluded stent-graft and pseudoaneurysm were confirmed in an emergent surgery when the distal end of the occluded stent-graft was seen to protrude from the external iliac artery.

View larger version (105K): [in a new window]   Figure 7d.   Pseudoaneurysm caused by graft infection in an 82-year-old man with an infrarenal aortic aneurysm. (a) Abdominal radiograph obtained 2 weeks after tapered stent-graft implantation from the aorta to the right iliac artery combined with left common iliac artery occlusion, coil embolization of the left internal iliac artery, and ilioiliac bypass grafting reveals the occluded stent-graft placed at the narrowing of the left common iliac artery as it runs peripherally (arrows). (b) Digital subtraction angiogram obtained 2 weeks after the procedure shows no abnormal findings. (c) Axial CT image obtained 2 weeks after the procedure shows no abnormal findings at the distal end of the occluded stent-graft. (d) Axial CT scan obtained 2 months after the procedure shows development of a soft-tissue-attenuating area (arrows) around the distal end of the occluded stent-graft (arrowheads). The patient had fever, left inguinal swelling, and tenderness. (e) Abdominal radiograph obtained 2 months after the procedure shows expansion of the distal end of the occluded stent-graft (arrows). (f) Digital subtraction angiogram obtained 2 months after the procedure reveals pseudoaneurysmal formation around the distal end of the occluded stent-graft (arrows). Infection of the occluded stent-graft and pseudoaneurysm were confirmed in an emergent surgery when the distal end of the occluded stent-graft was seen to protrude from the external iliac artery.

View larger version (152K): [in a new window]   Figure 7e.   Pseudoaneurysm caused by graft infection in an 82-year-old man with an infrarenal aortic aneurysm. (a) Abdominal radiograph obtained 2 weeks after tapered stent-graft implantation from the aorta to the right iliac artery combined with left common iliac artery occlusion, coil embolization of the left internal iliac artery, and ilioiliac bypass grafting reveals the occluded stent-graft placed at the narrowing of the left common iliac artery as it runs peripherally (arrows). (b) Digital subtraction angiogram obtained 2 weeks after the procedure shows no abnormal findings. (c) Axial CT image obtained 2 weeks after the procedure shows no abnormal findings at the distal end of the occluded stent-graft. (d) Axial CT scan obtained 2 months after the procedure shows development of a soft-tissue-attenuating area (arrows) around the distal end of the occluded stent-graft (arrowheads). The patient had fever, left inguinal swelling, and tenderness. (e) Abdominal radiograph obtained 2 months after the procedure shows expansion of the distal end of the occluded stent-graft (arrows). (f) Digital subtraction angiogram obtained 2 months after the procedure reveals pseudoaneurysmal formation around the distal end of the occluded stent-graft (arrows). Infection of the occluded stent-graft and pseudoaneurysm were confirmed in an emergent surgery when the distal end of the occluded stent-graft was seen to protrude from the external iliac artery.

View larger version (201K): [in a new window]   Figure 7f.   Pseudoaneurysm caused by graft infection in an 82-year-old man with an infrarenal aortic aneurysm. (a) Abdominal radiograph obtained 2 weeks after tapered stent-graft implantation from the aorta to the right iliac artery combined with left common iliac artery occlusion, coil embolization of the left internal iliac artery, and ilioiliac bypass grafting reveals the occluded stent-graft placed at the narrowing of the left common iliac artery as it runs peripherally (arrows). (b) Digital subtraction angiogram obtained 2 weeks after the procedure shows no abnormal findings. (c) Axial CT image obtained 2 weeks after the procedure shows no abnormal findings at the distal end of the occluded stent-graft. (d) Axial CT scan obtained 2 months after the procedure shows development of a soft-tissue-attenuating area (arrows) around the distal end of the occluded stent-graft (arrowheads). The patient had fever, left inguinal swelling, and tenderness. (e) Abdominal radiograph obtained 2 months after the procedure shows expansion of the distal end of the occluded stent-graft (arrows). (f) Digital subtraction angiogram obtained 2 months after the procedure reveals pseudoaneurysmal formation around the distal end of the occluded stent-graft (arrows). Infection of the occluded stent-graft and pseudoaneurysm were confirmed in an emergent surgery when the distal end of the occluded stent-graft was seen to protrude from the external iliac artery.

View larger version (108K): [in a new window]   Figure 8a.   Graft occlusion after tapered stent-graft implantation from the aorta to the right iliac artery in a 72-year-old man with an infrarenal abdominal aortic aneurysm. (a) Preprocedural curved-planar reconstruction image shows an infrarenal abdominal aortic aneurysm with a tortuous proximal neck of the aneurysm. (b) Follow-up curved-planar reconstruction image obtained 3 days after the procedure reveals that the stent-graft does not bend along the tortuous proximal neck of the aneurysm. Note weaker enhancement inside than outside the stent-graft (proximal endoleak [arrows]). (c) Digital subtraction angiogram obtained 14 days after the procedure shows occlusion of the stent-graft. Both of the patient's legs were pale, and a femoral pulse was not detected.

View larger version (111K): [in a new window]   Figure 8b.   Graft occlusion after tapered stent-graft implantation from the aorta to the right iliac artery in a 72-year-old man with an infrarenal abdominal aortic aneurysm. (a) Preprocedural curved-planar reconstruction image shows an infrarenal abdominal aortic aneurysm with a tortuous proximal neck of the aneurysm. (b) Follow-up curved-planar reconstruction image obtained 3 days after the procedure reveals that the stent-graft does not bend along the tortuous proximal neck of the aneurysm. Note weaker enhancement inside than outside the stent-graft (proximal endoleak [arrows]). (c) Digital subtraction angiogram obtained 14 days after the procedure shows occlusion of the stent-graft. Both of the patient's legs were pale, and a femoral pulse was not detected.

View larger version (129K): [in a new window]   Figure 8c.   Graft occlusion after tapered stent-graft implantation from the aorta to the right iliac artery in a 72-year-old man with an infrarenal abdominal aortic aneurysm. (a) Preprocedural curved-planar reconstruction image shows an infrarenal abdominal aortic aneurysm with a tortuous proximal neck of the aneurysm. (b) Follow-up curved-planar reconstruction image obtained 3 days after the procedure reveals that the stent-graft does not bend along the tortuous proximal neck of the aneurysm. Note weaker enhancement inside than outside the stent-graft (proximal endoleak [arrows]). (c) Digital subtraction angiogram obtained 14 days after the procedure shows occlusion of the stent-graft. Both of the patient's legs were pale, and a femoral pulse was not detected.

View larger version (146K): [in a new window]   Figure 9a.   Shower embolism after stent-graft implantation in a 78-year-old woman with an infrarenal aortic aneurysm. (a) Preprocedural axial CT scan obtained at the level of the suprarenal abdominal aorta shows intraluminal shaggy thrombus. (b) Preprocedural shaded surface display CT image shows an irregular surface of the flow lumen of the abdominal aorta caused by shaggy thrombus. The patient died of renal failure and disseminated intravascular coagulation 3 days after the procedure. Shower embolism was confirmed at autopsy.

View larger version (128K): [in a new window]   Figure 9b.   Shower embolism after stent-graft implantation in a 78-year-old woman with an infrarenal aortic aneurysm. (a) Preprocedural axial CT scan obtained at the level of the suprarenal abdominal aorta shows intraluminal shaggy thrombus. (b) Preprocedural shaded surface display CT image shows an irregular surface of the flow lumen of the abdominal aorta caused by shaggy thrombus. The patient died of renal failure and disseminated intravascular coagulation 3 days after the procedure. Shower embolism was confirmed at autopsy.

View larger version (169K): [in a new window]   Figure 10a.   Perforation of the mural thrombus by means of inadvertent penetration of the delivery system in a 52-year-old man with a distal arch aneurysm. (a) Intraoperative digital subtraction angiogram obtained immediately after insertion of the delivery system reveals that some parts of the delivery system are outside the opacified lumen (arrows). (b) Transesophageal echocardiogram obtained before introduction of the guide wire shows a moderate amount of mural thrombus in the aortic arch (arrows). (c) Transesophageal echocardiogram obtained after introduction of the guide wire reveals that the mural thrombus is partially torn by the guide wire (arrowhead). (d) Transesophageal echocardiogram shows the delivery system (arrows) within the mural thrombus. (e) Preoperative axial CT image shows a moderate amount of the mural thrombus in the aneurysm. (f) Postoperative axial CT image depicts perforation of the mural thrombus. Dorsal thrombus is transposed to the right side (arrows) by the stent-graft as placed in the mural thrombus with the delivery system.

View larger version (150K): [in a new window]   Figure 10b.   Perforation of the mural thrombus by means of inadvertent penetration of the delivery system in a 52-year-old man with a distal arch aneurysm. (a) Intraoperative digital subtraction angiogram obtained immediately after insertion of the delivery system reveals that some parts of the delivery system are outside the opacified lumen (arrows). (b) Transesophageal echocardiogram obtained before introduction of the guide wire shows a moderate amount of mural thrombus in the aortic arch (arrows). (c) Transesophageal echocardiogram obtained after introduction of the guide wire reveals that the mural thrombus is partially torn by the guide wire (arrowhead). (d) Transesophageal echocardiogram shows the delivery system (arrows) within the mural thrombus. (e) Preoperative axial CT image shows a moderate amount of the mural thrombus in the aneurysm. (f) Postoperative axial CT image depicts perforation of the mural thrombus. Dorsal thrombus is transposed to the right side (arrows) by the stent-graft as placed in the mural thrombus with the delivery system.

View larger version (153K): [in a new window]   Figure 10c.   Perforation of the mural thrombus by means of inadvertent penetration of the delivery system in a 52-year-old man with a distal arch aneurysm. (a) Intraoperative digital subtraction angiogram obtained immediately after insertion of the delivery system reveals that some parts of the delivery system are outside the opacified lumen (arrows). (b) Transesophageal echocardiogram obtained before introduction of the guide wire shows a moderate amount of mural thrombus in the aortic arch (arrows). (c) Transesophageal echocardiogram obtained after introduction of the guide wire reveals that the mural thrombus is partially torn by the guide wire (arrowhead). (d) Transesophageal echocardiogram shows the delivery system (arrows) within the mural thrombus. (e) Preoperative axial CT image shows a moderate amount of the mural thrombus in the aneurysm. (f) Postoperative axial CT image depicts perforation of the mural thrombus. Dorsal thrombus is transposed to the right side (arrows) by the stent-graft as placed in the mural thrombus with the delivery system.

View larger version (162K): [in a new window]   Figure 10d.   Perforation of the mural thrombus by means of inadvertent penetration of the delivery system in a 52-year-old man with a distal arch aneurysm. (a) Intraoperative digital subtraction angiogram obtained immediately after insertion of the delivery system reveals that some parts of the delivery system are outside the opacified lumen (arrows). (b) Transesophageal echocardiogram obtained before introduction of the guide wire shows a moderate amount of mural thrombus in the aortic arch (arrows). (c) Transesophageal echocardiogram obtained after introduction of the guide wire reveals that the mural thrombus is partially torn by the guide wire (arrowhead). (d) Transesophageal echocardiogram shows the delivery system (arrows) within the mural thrombus. (e) Preoperative axial CT image shows a moderate amount of the mural thrombus in the aneurysm. (f) Postoperative axial CT image depicts perforation of the mural thrombus. Dorsal thrombus is transposed to the right side (arrows) by the stent-graft as placed in the mural thrombus with the delivery system.

View larger version (129K): [in a new window]   Figure 10e.   Perforation of the mural thrombus by means of inadvertent penetration of the delivery system in a 52-year-old man with a distal arch aneurysm. (a) Intraoperative digital subtraction angiogram obtained immediately after insertion of the delivery system reveals that some parts of the delivery system are outside the opacified lumen (arrows). (b) Transesophageal echocardiogram obtained before introduction of the guide wire shows a moderate amount of mural thrombus in the aortic arch (arrows). (c) Transesophageal echocardiogram obtained after introduction of the guide wire reveals that the mural thrombus is partially torn by the guide wire (arrowhead). (d) Transesophageal echocardiogram shows the delivery system (arrows) within the mural thrombus. (e) Preoperative axial CT image shows a moderate amount of the mural thrombus in the aneurysm. (f) Postoperative axial CT image depicts perforation of the mural thrombus. Dorsal thrombus is transposed to the right side (arrows) by the stent-graft as placed in the mural thrombus with the delivery system.

View larger version (153K): [in a new window]   Figure 10f.   Perforation of the mural thrombus by means of inadvertent penetration of the delivery system in a 52-year-old man with a distal arch aneurysm. (a) Intraoperative digital subtraction angiogram obtained immediately after insertion of the delivery system reveals that some parts of the delivery system are outside the opacified lumen (arrows). (b) Transesophageal echocardiogram obtained before introduction of the guide wire shows a moderate amount of mural thrombus in the aortic arch (arrows). (c) Transesophageal echocardiogram obtained after introduction of the guide wire reveals that the mural thrombus is partially torn by the guide wire (arrowhead). (d) Transesophageal echocardiogram shows the delivery system (arrows) within the mural thrombus. (e) Preoperative axial CT image shows a moderate amount of the mural thrombus in the aneurysm. (f) Postoperative axial CT image depicts perforation of the mural thrombus. Dorsal thrombus is transposed to the right side (arrows) by the stent-graft as placed in the mural thrombus with the delivery system.

View larger version (184K): [in a new window]   Figure 11a.   Colon necrosis after stent-graft implantation in a 71-year-old man with an infrarenal abdominal aortic aneurysm. (a) Preprocedural axial CT image shows a large patent inferior mesenteric artery (arrow). (b) Intraoperative photograph shows necrosis of the sigmoid colon (arrows).

View larger version (164K): [in a new window]   Figure 11b.   Colon necrosis after stent-graft implantation in a 71-year-old man with an infrarenal abdominal aortic aneurysm. (a) Preprocedural axial CT image shows a large patent inferior mesenteric artery (arrow). (b) Intraoperative photograph shows necrosis of the sigmoid colon (arrows).

View larger version (132K): [in a new window]   Figure 12.   Aortic dissection in a 71-year-old woman. Axial CT image obtained 25 days after stent-graft implantation to treat a distal arch aneurysm shows dissection of the descending thoracic aorta and pleural effusion.

View larger version (131K): [in a new window]   Figure 13.   Hematoma at the arteriotomy site in a 78-year-old woman with an infrarenal abdominal aortic aneurysm. Follow-up axial CT image obtained 2 days after stent-graft implantation shows a large high-attenuating area (arrows) around the right external iliac artery.