Skip to main content
SpringerLink
Log in

Aortic Aneurysm and Stent Graft Assessment

  • Chapter
  • First Online:
Multislice CT

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 3175 Accesses

Abstract

Aortic aneurysms have a high incidence rate within the United States and are associated with significant morbidity and mortality. With the emergence of technical advances in CT technology, Multi-detector row technology with high-resolution CTA and postprocessing has become the standard of care in the pretreatment evaluation and follow-up of patients being considered for endovascular aortic repair. The aim of this chapter is to provide details for CT/CTA diagnosis of aortic aneurysms, with focus on the pre- and postoperative evaluation of TEVAR and EVAR.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Agarwal PP, Chughtai A, Matzinger FR, Kazerooni EA (2009) Multidetector CT of thoracic aortic aneurysms 1. Radiographics 29(2):537–552

    PubMed  Google Scholar 

  • Alexander SA, Rubin GD (eds) (2009) Imaging the thoracic aorta: anatomy, technical considerations, and trauma. Semin Roentgenol 44:8–15

    Google Scholar 

  • Armon M, Yusuf S, Whitaker S, Gregson R, Wenham P, Hopkinson B (1998) Thrombus distribution and changes in aneurysm size following endovascular aortic aneurysm repair. Eur J Vasc Endovasc Surg 16(6):472–476

    CAS  PubMed  Google Scholar 

  • Bischoff MS, Geisbüsch P, Kotelis D, Müller-Eschner M, Hyhlik-Dürr A, Böckler D (2013) Clinical significance of type II endoleaks after thoracic endovascular aortic repair. J Vasc Surg 58(3):643–650

    PubMed  Google Scholar 

  • Blankensteijn JD, Eikelboom BC (1999) Patient selection for endovascular abdominal aortic aneurysm repair. Vasc Endovasc Surg 33(4):347

    Google Scholar 

  • Brady AR, Thompson SG, Fowkes FGR, Greenhalgh RM, Powell JT (2004) Abdominal aortic aneurysm expansion risk factors and time intervals for surveillance. Circulation 110(1):16–21

    PubMed  Google Scholar 

  • Bruen KJ, Feezor RJ, Daniels MJ, Beck AW, Lee WA (2011) Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms. J Vasc Surg 53(4):895–905

    PubMed  Google Scholar 

  • Brunkwall J, Hauksson H, Bengtsson H, Bergqvist D, Takolander R, Bergentz S-E (1989) Solitary aneurysms of the iliac arterial system: an estimate of their frequency of occurrence. J Vasc Surg 10(4):381–384

    CAS  PubMed  Google Scholar 

  • Bryce Y, Rogoff P, Romanelli D, Reichle R (2015) Endovascular repair of abdominal aortic aneurysms: vascular anatomy, device selection, procedure, and procedure-specific complications. Radiographics 35(2):593–615

    PubMed  Google Scholar 

  • Cejna M, Loewe C, Schoder M, Dirisamer A, Hölzenbein T, Kretschmer G et al (2002) MR angiography vs CT angiography in the follow-up of nitinol stent grafts in endoluminally treated aortic aneurysms. Eur Radiol 12(10):2443–2450

    PubMed  Google Scholar 

  • Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA et al (2009a) SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary. J Vasc Surg 50(4):880–896

    PubMed  Google Scholar 

  • Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA et al (2009b) The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 50(4):S2–S49

    PubMed  Google Scholar 

  • Cheng D, Martin J, Shennib H, Dunning J, Muneretto C, Schueler S et al (2010) Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease: a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol 55(10):986–1001

    PubMed  Google Scholar 

  • Cho J-S, Makaroun MS (2006) US multicenter trials of endoprostheses for the endovascular treatment of descending thoracic aneurysms. J Vasc Surg 43(2):12A–19A

    PubMed  Google Scholar 

  • Chung JW, Kim H-C, Choi YH, Kim SJ, Lee W, Park JH (2007) Patterns of aortic involvement in Takayasu arteritis and its clinical implications: evaluation with spiral computed tomography angiography. J Vasc Surg 45(5):906–914

    PubMed  Google Scholar 

  • Cohen EI, Weinreb DB, Siegelbaum RH, Honig S, Marin M, Weintraub JL et al (2008) Time-resolved MR angiography for the classification of endoleaks after endovascular aneurysm repair. J Magn Reson Imaging 27(3):500–503

    PubMed  Google Scholar 

  • Committee LRoEARS (2002) Lifeline registry of endovascular aneurysm repair: registry data report. J Vasc Surg 35(3):616–620

    Google Scholar 

  • Criado FJ, Clark NS, Barnatan MF (2002) Stent graft repair in the aortic arch and descending thoracic aorta: a 4-year experience. J Vasc Surg 36(6):1121–1128

    PubMed  Google Scholar 

  • Criado FJ, Abul-Khoudoud OR, Domer GS, McKendrick C, Zuzga M, Clark NS et al (2005) Endovascular repair of the thoracic aorta: lessons learned. Ann Thorac Surg 80(3):857–863

    PubMed  Google Scholar 

  • De Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW et al (2010) Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 362(20):1881–1889

    PubMed  Google Scholar 

  • Duke R, Barrett M II, Payne S, Salazar J, Winer-Muram H, Tonkin I (1987) Compression of left main bronchus and left pulmonary artery by thoracic aortic aneurysm. Am J Roentgenol 149(2):261–263

    CAS  Google Scholar 

  • Elefteriades JA (2002) Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg 74(5):S1877–S1S80

    PubMed  Google Scholar 

  • Gadowski GR, Pilcher DB, Ricci MA (1994) Abdominal aortic aneurysm expansion rate: effect of size and beta-adrenergic blockade. J Vasc Surg 19(4):727–731

    CAS  PubMed  Google Scholar 

  • Gonsalves CF (1999) The hyperattenuating crescent sign 1. Radiology 211(1):37–38

    CAS  PubMed  Google Scholar 

  • Hansen CJ, Bui H, Donayre CE, Aziz I, Kim B, Kopchok G et al (2004) Complications of endovascular repair of high-risk and emergent descending thoracic aortic aneurysms and dissections. J Vasc Surg 40(2):228–234

    PubMed  Google Scholar 

  • Harris PL, Vallabhaneni SR, Desgranges P, Becquemin J-P, van Marrewijk C, Laheij RJ (2000) Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. J Vasc Surg 32(4):739–749

    CAS  PubMed  Google Scholar 

  • Hiatt MD, Rubin GD (eds) (2004) Surveillance for endoleaks: how to detect all of them. Semin Vasc Surg 17:268–278

    Google Scholar 

  • Huang B, Li J, Law MW, Zhang J, Shen Y, Khong P (2010) Radiation dose and cancer risk in retrospectively and prospectively ECG-gated coronary angiography using 64-slice multidetector CT. Br J Radiol 83:152–158

    CAS  PubMed  PubMed Central  Google Scholar 

  • Iezzi R, Cotroneo AR, Marano R, Filippone A, Storto ML (2008) Endovascular treatment of thoracic aortic diseases: follow-up and complications with multi-detector computed tomography angiography. Eur J Radiol 65(3):365–376

    PubMed  Google Scholar 

  • Investigators UKET (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010(362):1863–1871

    Google Scholar 

  • Javor D, Wressnegger A, Unterhumer S, Kollndorfer K, Nolz R, Beitzke D et al (2017) Endoleak detection using single-acquisition split-bolus dual-energy computer tomography (DECT). Eur Radiol:1622–1630

    Google Scholar 

  • Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC (1991) Suggested standards for reporting on arterial aneurysms. J Vasc Surg 13(3):452–458

    CAS  PubMed  Google Scholar 

  • Jones JE, Atkins MD, Brewster DC, Chung TK, Kwolek CJ, LaMuraglia GM et al (2007) Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg 46(1):1–8

    PubMed  Google Scholar 

  • Kicska G, Litt H (eds) (2009) Preprocedural planning for endovascular stent-graft placement. Semin Intervent Radiol 26:44–55

    Google Scholar 

  • Kristmundsson T, Sonesson B, Malina M, Björses K, Dias N, Resch T (2009) Fenestrated endovascular repair for juxtarenal aortic pathology. J Vasc Surg 49(3):568–575

    PubMed  Google Scholar 

  • Kumeda H, Tomita Y, Morita S, Yasui H (2005) Compression of trachea and left main bronchus by arch aneurysm. Ann Thorac Surg 79(3):1038–1040

    PubMed  Google Scholar 

  • Laks S, Macari M, Chandarana H (eds) (2010) Dual-energy computed tomography imaging of the aorta after endovascular repair of abdominal aortic aneurysm. Semin Ultrasound CT MRI 31:292–300

    Google Scholar 

  • LaRoy LL, Cormier P, Matalon T, Patel S, Turner D, Silver B (1989) Imaging of abdominal aortic aneurysms. Am J Roentgenol 152(4):785–792

    CAS  Google Scholar 

  • Lederle FA, Johnson GR, Wilson SE (2001) Abdominal aortic aneurysm in women. J Vasc Surg 34(1):122–126

    CAS  PubMed  Google Scholar 

  • Lehmkuhl L, Andres C, Lücke C, Foldyna B, Grothoff M, Scheinert D et al (2012) Dynamic CT angiography after abdominal aortic endovascular aneurysm repair: differences in contrast agent dynamics in the aorta and endoleaks—preliminary results. J Vasc Interv Radiol 23(6):744–750

    PubMed  Google Scholar 

  • Leonard WT, MacKenzie KS, Montreuil B, Obrand DI, Steinmetz OK (2004) The proximal landing zone in endovascular repair of the thoracic aorta. Ann Vasc Surg 18(2):178–185

    Google Scholar 

  • Leurs LJ, Bell R, Degrieck Y, Thomas S, Hobo R, Lundbom J (2004) Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries. J Vasc Surg 40(4):670–679

    PubMed  Google Scholar 

  • McPhee JT, Hill JS, Eslami MH (2007) The impact of gender on presentation, therapy, and mortality of abdominal aortic aneurysm in the United States, 2001–2004. J Vasc Surg 45(5):891–899

    PubMed  Google Scholar 

  • Melissano G, Civilini E, Bertoglio L, Calliari F, Setacci F, Calori G et al (2007) Results of endografting of the aortic arch in different landing zones. Eur J Vasc Endovasc Surg 33(5):561–566

    CAS  PubMed  Google Scholar 

  • Morishita K, Kurimoto Y, Kawaharada N, Fukada J, Hachiro Y, Fujisawa Y et al (2004) Descending thoracic aortic rupture: role of endovascular stent-grafting. Ann Thorac Surg 78(5):1630–1634

    PubMed  Google Scholar 

  • Murashita T, Matsuda H, Domae K, Iba Y, Tanaka H, Sasaki H et al (2012) Less invasive surgical treatment for aortic arch aneurysms in high-risk patients: a comparative study of hybrid thoracic endovascular aortic repair and conventional total arch replacement. J Thorac Cardiovasc Surg 143(5):1007–1013

    PubMed  Google Scholar 

  • Mursalin R, Sakamoto I, Nagayama H, Sueyoshi E, Tanigawa K, Miura T et al (2016) Imaging-based predictors of persistent type II endoleak after endovascular abdominal aortic aneurysm repair. Am J Roentgenol 206(6):1335–1340

    Google Scholar 

  • Neequaye S, Abraham CZ (2013) Total endograft replacement of aortic arch. Ann Cardiothorac Surg 2(3):362–366

    PubMed  PubMed Central  Google Scholar 

  • Pande RL, Beckman JA (2008) Abdominal aortic aneurysm: populations at risk and how to screen. J Vasc Interv Radiol 19(6):S2–S8

    PubMed  Google Scholar 

  • Parmer SS, Carpenter JP, Stavropoulos SW, Fairman RM, Pochettino A, Woo EY et al (2006) Endoleaks after endovascular repair of thoracic aortic aneurysms. J Vasc Surg 44(3):447–452

    PubMed  Google Scholar 

  • Piffaretti G, Mariscalco G, Lomazzi C, Rivolta N, Riva F, Tozzi M et al (2009) Predictive factors for endoleaks after thoracic aortic aneurysm endograft repair. J Thorac Cardiovasc Surg 138(4):880–885

    PubMed  Google Scholar 

  • Posniak HV, Olson MC, Demos TC, Benjoya RA, Marsan RE (1990) CT of thoracic aortic aneurysms. Radiographics 10(5):839–855

    CAS  PubMed  Google Scholar 

  • Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R et al (2004) A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351(16):1607–1618

    CAS  PubMed  Google Scholar 

  • Raman R, Napel S, Beaulieu CF, Bain ES, Jeffrey RB Jr, Rubin GD (2002) Automated generation of curved planar reformations from volume data: method and evaluation 1. Radiology 223(1):275–280

    PubMed  Google Scholar 

  • Rayt H, Bown M, Lambert K, Fishwick N, McCarthy M, London N et al (2008) Buttock claudication and erectile dysfunction after internal iliac artery embolization in patients prior to endovascular aortic aneurysm repair. Cardiovasc Intervent Radiol 31(4):728–734

    CAS  PubMed  Google Scholar 

  • Roselli EE, Idrees J, Greenberg RK, Johnston DR, Lytle BW (2015) Endovascular stent grafting for ascending aorta repair in high-risk patients. J Thorac Cardiovasc Surg 149(1):144–154

    PubMed  Google Scholar 

  • Rydberg J, Kopecky KK, Lalka SG, Johnson MS, Dalsing MC, Persohn SA (2001) Stent grafting of abdominal aortic aneurysms: pre-and postoperative evaluation with multislice helical CT. J Comput Assist Tomogr 25(4):580–586

    CAS  PubMed  Google Scholar 

  • Schermerhorn ML, O’Malley AJ, Jhaveri A, Cotterill P, Pomposelli F, Landon BE (2008) Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 358(5):464–474

    CAS  PubMed  Google Scholar 

  • Serag A, Bergeron P, Mathieu X, Piret V, Petrosyan A, Gay J (2007) Identification of proximal landing zone limit for proper deployment of aortic arch stentgraft after supra-aortic great vessels transposition. J Cardiovasc Surg 48(6):805

    CAS  Google Scholar 

  • Siegel CL, Cohan R, Korobkin M, Alpern M, Courneya D, Leder R (1994) Abdominal aortic aneurysm morphology: CT features in patients with ruptured and nonruptured aneurysms. AJR Am J Roentgenol 163(5):1123–1129

    CAS  PubMed  Google Scholar 

  • Silverberg E, Boring CC, Squires TS (1990) Cancer statistics, 1990. CA Cancer J Clin 40(1):9–26

    CAS  PubMed  Google Scholar 

  • Sommer WH, Graser A, Becker CR, Clevert DA, Reiser MF, Nikolaou K et al (2010) Image quality of virtual noncontrast images derived from dual-energy CT angiography after endovascular aneurysm repair. J Vasc Interv Radiol 21(3):315–321

    PubMed  Google Scholar 

  • Sommer WH, Becker CR, Haack M, Rubin GD, Weidenhagen R, Schwarz F et al (2012) Time-resolved CT angiography for the detection and classification of endoleaks. Radiology 263(3):917–926

    PubMed  Google Scholar 

  • Stanley BM, Semmens JB, Mai Q, Goodman MA, Hartley DE, Wilkinson C et al (2001) Evaluation of patient selection guidelines for endoluminal AAA repair with the Zenith Stent-Graft: the Australasian experience. J Endovasc Ther 8(5):457–464

    CAS  PubMed  Google Scholar 

  • Stavropoulos SW, Charagundla SR (2007) Imaging techniques for detection and management of endoleaks after endovascular aortic aneurysm repair 1. Radiology 243(3):641–655

    PubMed  Google Scholar 

  • Sternbergh WC, Money SR, Greenberg RK, Chuter TA, Investigators Z (2004) Influence of endograft oversizing on device migration, endoleak, aneurysm shrinkage, and aortic neck dilation: results from the Zenith Multicenter Trial. J Vasc Surg 39(1):20–26

    PubMed  Google Scholar 

  • Stolzmann P, Frauenfelder T, Pfammatter T, Peter N, Scheffel H, Lachat M et al (2008) Endoleaks after endovascular abdominal aortic aneurysm repair: detection with dual-energy dual-source CT 1. Radiology 249(2):682–691

    PubMed  Google Scholar 

  • Sun Z-H (2012) Abdominal aortic aneurysm: treatment options, image visualizations and follow-up procedures. J Geriatr Cardiol 9(1):49–60

    CAS  PubMed  PubMed Central  Google Scholar 

  • Sun Z, Winder RJ, Kelly BE, Ellis PK, Kennedy PT, Hirst DG (2004) Diagnostic value of CT virtual intravascular endoscopy in aortic stent-grafting. J Endovasc Ther 11(1):13–25

    PubMed  Google Scholar 

  • Sun Z, O’Donnell ME, Winder RJ, Ellis PK, Blair PH (2007) Effect of suprarenal fixation of aortic stent-grafts on the renal artery ostia: assessment of morphological changes by virtual intravascular endoscopy. J Endovasc Ther 14(5):650–660

    PubMed  Google Scholar 

  • Tsilimparis N, Debus S, Oderich GS, Haulon S, Terp KA, Detter C et al (2015) RR23. Multicenter international experience with endovascular treatment of ascending aortic pathology in high-risk patients with a specifically designed ascending aortic stent graft. J Vasc Surg 61(6):200S

    Google Scholar 

  • Uberoi R, Tsetis D, Shrivastava V, Morgan R, Belli A-M (2011) Standard of practice for the interventional management of isolated iliac artery aneurysms. Cardiovasc Intervent Radiol 34(1):3–13

    PubMed  Google Scholar 

  • Ueda T, Fleischmann D, Rubin GD, Dake MD, Sze DY (eds) (2008) Imaging of the thoracic aorta before and after stent-graft repair of aneurysms and dissections. Semin Thorac Cardiovasc Surg 20:348–357

    Google Scholar 

  • Ueda T, Fleischmann D, Dake MD, Rubin GD, Sze DY (2010) Incomplete endograft apposition to the aortic arch: bird-beak configuration increases risk of endoleak formation after thoracic endovascular aortic repair 1. Radiology 255(2):645–652

    PubMed  Google Scholar 

  • Ueda T, Takaoka H, Raman B, Rosenberg J, Rubin GD (2011) Impact of quantitatively determined native thoracic aortic tortuosity on endoleak development after thoracic endovascular aortic repair. Am J Roentgenol 197(6):W1140–W1146

    Google Scholar 

  • Verhoeven E, Vourliotakis G, Bos W, Tielliu I, Zeebregts C, Prins T et al (2010) Fenestrated stent grafting for short-necked and juxtarenal abdominal aortic aneurysm: an 8-year single-centre experience. Eur J Vasc Endovasc Surg 39(5):529–536

    CAS  PubMed  Google Scholar 

  • Vishal Sharma M (2011) Abdominal aortic aneurysm: a comprehensive review. Exp Clin Cardiol 16:11–15

    PubMed  PubMed Central  Google Scholar 

  • Whitaker S (2001) Imaging of abdominal aortic aneurysm before and after endoluminal stent-graft repair. Eur J Radiol 39(1):3–15

    CAS  PubMed  Google Scholar 

  • White GH, Yu W, May J, Chaufour X, Stephen MS (1997) Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: classification, incidence, diagnosis, and management. J Endovasc Ther 4(2):152–168

    CAS  Google Scholar 

  • White GH, May J, Waugh RC, Chaufour X, Yu W (1998) Type III and type IV endoleak: toward a complete definition of blood flow in the sac after endoluminal AAA repair. J Endovasc Ther 5(4):305–309

    CAS  Google Scholar 

  • Zarins C, Hill B, Wolf Y (2001) Aneurysmal vascular disease. In: Sabiston textbook of surgery, 16th edn. Saunders, Philadelphia, PA, pp 1357–1372

    Google Scholar 

  • Zhuge F, Rubin GD, Sun S, Napel S (2006) An abdominal aortic aneurysm segmentation method: level set with region and statistical information. Med Phys 33(5):1440–1453

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Vascular and Interventional Radiology, The Mount Sinai Hospital, 1184 Fifth Avenue, MC Level, Room 801, New York, NY, 10029, USA

    Ilya Livshits M.D., Safet Lekperic M.D. & Robert Lookstein MD, MHCDL, FSIR, FAHA

Authors
  1. Ilya Livshits M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Safet Lekperic M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert Lookstein MD, MHCDL, FSIR, FAHA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert Lookstein MD, MHCDL, FSIR, FAHA .

Editor information

Editors and Affiliations

  1. Department of Radiology, Universitätsklinikum Tübingen, Tübingen, Baden-Württemberg, Germany

    Konstantin Nikolaou

  2. Department of Diagnostic and Interventional Radiology, University of Freiburg, Freiburg, Germany

    Fabian Bamberg

  3. Department of Surgical and Medical Sciences and Translational Medicine, “Sapienza” – University of Rome, Rome, Italy

    Andrea Laghi

  4. Department of Radiology, Duke University School of Medicine, Durham, NC, USA

    Geoffrey D. Rubin

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Livshits, I., Lekperic, S., Lookstein, R. (2017). Aortic Aneurysm and Stent Graft Assessment. In: Nikolaou, K., Bamberg, F., Laghi, A., Rubin, G.D. (eds) Multislice CT. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2017_106

Download citation

  • DOI: https://doi.org/10.1007/174_2017_106

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42585-6

  • Online ISBN: 978-3-319-42586-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation