Skip to main content

Advertisement

SpringerLink
Log in

Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

Endovascular aneurysm repair of the infrarenal or thoracic aorta has been shown to be a less invasive alternative to open surgery. A combined aneurysm of the thoracic and abdominal aorta is complex and challenging; the involvement of renal and/or visceral branches requires new treatment methods.

Methods

A hybrid approach is currently an accepted alternative to conventional surgery. Renal and/or visceral revascularisation enables subsequent stent-graft placement into the visceral portion of the aorta.

Results

Knowledge of the surgical procedure and a precise assessment of the vascular morphology are crucial for pre-procedural planning and for detection of post-procedural complications. Multi-detector computed tomography angiography (MDCTA) combined with two- and three-dimensional (2D and 3D) rendering is useful for pre-interventional planning and for the detection of post-procedural complications. Three-dimensional rendering allows proper anatomical analyses, influencing interventional strategies and resulting in a better outcome.

Conclusions

With the knowledge of procedure-specific MDCTA findings in various vascular conditions, the radiologist and surgeon are able to perform an efficient pre-interventional planning and follow-up examination. Based on our experience with this novel technique of combined open and endovascular aortic aneurysm treatment, this pictorial review illustrates procedure-specific imaging findings, including common and rare complications, with respect to 2D and 3D post-processing techniques.

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1a, b
Fig. 2
Fig. 3
Fig. 4a, b
Fig. 5
Fig. 6
Fig. 7a, b
Fig. 8a, b
Fig. 9a, b
Fig. 10a, b
Fig. 11
Fig. 12a, b
Fig. 13
Fig. 14
Fig. 15a, b
Fig. 16
Fig. 17

Similar content being viewed by others

Explore related subjects

Discover the latest articles, news and stories from top researchers in related subjects.

References

  1. Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491–499

    Article  CAS  PubMed  Google Scholar 

  2. Prinssen M, Verhoeven EL, Buth J et al (2004) A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. New Engl J Med 351:1607–1618

    Article  CAS  PubMed  Google Scholar 

  3. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG (2004) Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 364:843–848

    Article  CAS  PubMed  Google Scholar 

  4. Quinones-Baldrich WJ, Panetta TF, Vescera CL, Kashyap VS (1999) Repair of type IV thoracoabdominal aneurysm with a combined endovascular and surgical approach. J Vasc Surg 30:555–560

    Article  CAS  PubMed  Google Scholar 

  5. Fulton JJ, Farber MA, Marston WA, Mendes R, Mauro MA, Keagy BA (2005) Endovascular stent-graft repair of pararenal and type IV thoracoabdominal aortic aneurysms with adjunctive visceral reconstruction. J Vasc Surg 41:191–198

    Article  PubMed  Google Scholar 

  6. Black SA, Wolfe JH, Clark M, Hamady M, Cheshire NJ, Jenkins MP (2006) Complex thoracoabdominal aortic aneurysms: endovascular exclusion with visceral revascularization. J Vasc Surg 43:1081–1089 discussion 1089

    Article  PubMed  Google Scholar 

  7. Chiesa R, Tshomba Y, Melissano G et al (2007) Hybrid approach to thoracoabdominal aortic aneurysms in patients with prior aortic surgery. J Vasc Surg 45:1128–1135

    Article  PubMed  Google Scholar 

  8. Resch TA, Greenberg RK, Lyden SP et al (2006) Combined staged procedures for the treatment of thoracoabdominal aneurysms. J Endovasc Ther 13:481–489

    Article  PubMed  Google Scholar 

  9. Donas KP, Czerny M, Guber I, Teufelsbauer H, Nanobachvili J (2007) Hybrid open-endovascular repair for thoracoabdominal aortic aneurysms: current status and level of evidence. Eur J Vasc Endovasc Surg 34:528–533

    Article  CAS  PubMed  Google Scholar 

  10. Donas KP, Schulte S, Krause E, Horsch S (2007) Combined endovascular stent-graft repair and adjunctive visceral vessel reconstruction for complex thoracoabdominal aortic aneurysms. Int Angiol 26:213–218

    CAS  PubMed  Google Scholar 

  11. Bockler D, Kotelis D, Geisbusch P et al (2008) Hybrid procedures for thoracoabdominal aortic aneurysms and chronic aortic dissections—a single center experience in 28 patients. J Vasc Surg 47:724–732

    Article  PubMed  Google Scholar 

  12. Dauria DM, Dyk P, Garvin P (2006) Incidence and management of seroma after arteriovenous graft placement. J Am Coll Surg 203:506–511

    Article  PubMed  Google Scholar 

  13. Mii S, Mori A, Sakata H, Kawazoe N (1998) Para-anastomotic aneurysms: incidence, risk factors, treatment and prognosis. J Cardiovasc Surg 39:259–266

    CAS  Google Scholar 

  14. Mita T, Arita T, Matsunaga N et al (2000) Complications of endovascular repair for thoracic and abdominal aortic aneurysm: an imaging spectrum. Radiographics 20:1263–1278

    CAS  PubMed  Google Scholar 

  15. Lachat M, Mayer D, Criado FJ et al (2008) New technique to facilitate renal revascularization with use of telescoping self-expanding stent grafts: VORTEC. Vascular 16:69–72

    PubMed  Google Scholar 

  16. Rozenblit AM, Patlas M, Rosenbaum AT et al (2003) Detection of endoleaks after endovascular repair of abdominal aortic aneurysm: value of unenhanced and delayed helical CT acquisitions. Radiology 227:426–433

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  18. Cademartiri F, Mollet NR, van der Lugt A et al (2005) Intravenous contrast material administration at helical 16-detector row CT coronary angiography: effect of iodine concentration on vascular attenuation. Radiology 236:661–665

    Article  PubMed  Google Scholar 

  19. Fleischmann D (2003) Use of high concentration contrast media: principles and rationale-vascular district. Eur J Radiol 45(Suppl 1):S88–S93

    Article  PubMed  Google Scholar 

  20. Golzarian J, Dussaussois L, Abada HT et al (1998) Helical CT of aorta after endoluminal stent-graft therapy: value of biphasic acquisition. AJR Am J Roentgenol 171:329–331

    CAS  PubMed  Google Scholar 

  21. Iezzi R, Cotroneo AR, Filippone A et al (2006) Multidetector CT in abdominal aortic aneurysm treated with endovascular repair: are unenhanced and delayed phase enhanced images effective for endoleak detection? Radiology 241:915–921

    Article  PubMed  Google Scholar 

  22. Abada HT, Sapoval MR, Paul JF, de Maertelaer V, Mousseaux E, Gaux JC (2003) Aneurysmal sizing after endovascular repair in patients with abdominal aortic aneurysm: interobserver variability of various measurement protocols and its clinical relevance. Eur Radiol 13:2699–2704

    Article  PubMed  Google Scholar 

  23. Dalrymple NC, Prasad SR, Freckleton MW, Chintapalli KN (2005) Informatics in radiology (infoRAD): introduction to the language of three-dimensional imaging with multidetector CT. Radiographics 25:1409–1428

    Article  PubMed  Google Scholar 

  24. Crawford ES, Crawford JL, Safi HJ et al (1986) Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg 3:389–404

    Article  CAS  PubMed  Google Scholar 

  25. Safi HJ, Winnerkvist A, Miller CC 3rd et al (1998) Effect of extended cross-clamp time during thoracoabdominal aortic aneurysm repair. Ann Thorac Surg 66:1204–1209

    Article  CAS  PubMed  Google Scholar 

  26. Kawanishi Y, Okada K, Matsumori M et al (2007) Influence of perioperative hemodynamics on spinal cord ischemia in thoracoabdominal aortic repair. Ann Thorac Surg 84:488–492

    Article  PubMed  Google Scholar 

  27. Garzon G, Fernandez-Velilla M, Marti M, Acitores I, Ybanez F, Riera L (2005) Endovascular stent-graft treatment of thoracic aortic disease. Radiographics, 25(Suppl 1):S229–244

    Article  Google Scholar 

  28. Makaroun MS, Dillavou ED, Kee ST et al (2005) Endovascular treatment of thoracic aortic aneurysms: results of the phase II multicenter trial of the GORE TAG thoracic endoprosthesis. J Vasc Surg 41:1–9

    Article  PubMed  Google Scholar 

  29. Huber A, Matzko M, Wintersperger BJ, Reiser M (2001) [Reconstruction methods in postprocessing of CT- and MR-angiography of the aorta]. Radiologe 41:689–694

    Article  CAS  PubMed  Google Scholar 

  30. Aquino RV, Rhee RY, Muluk SC, Tzeng EY, Carrol NM, Makaroun MS (2001) Exclusion of accessory renal arteries during endovascular repair of abdominal aortic aneurysms. J Vasc Surg 34:878–884

    Article  CAS  PubMed  Google Scholar 

  31. Karmacharya J, Parmer SS, Antezana JN et al (2006) Outcomes of accessory renal artery occlusion during endovascular aneurysm repair. J Vasc Surg 43:8–13

    Article  PubMed  Google Scholar 

  32. Leurs LJ, Laheij RJ, Buth J (2005) What determines and are the consequences of surveillance intensity after endovascular abdominal aortic aneurysm repair? Ann Vasc Surg 19:868–875

    Article  PubMed  Google Scholar 

  33. Harris PL, Buth J, Mialhe C, Myhre HO, Norgren L (1997) The need for clinical trials of endovascular abdominal aortic aneurysm stent-graft repair: The EUROSTAR Project. EUROpean collaborators on Stent-graft Techniques for abdominal aortic Aneurysm Repair. J Endovasc Surg 4:72–77 discussion 78–79

    Article  CAS  PubMed  Google Scholar 

  34. Schlensak C, Doenst T, Hauer M et al (2001) Serious complications that require surgical interventions after endoluminal stent-graft placement for the treatment of infrarenal aortic aneurysms. J Vasc Surg 34:198–203

    Article  CAS  PubMed  Google Scholar 

  35. Kritpracha B, Beebe HG, Comerota AJ (2004) Aortic diameter is an insensitive measurement of early aneurysm expansion after endografting. J Endovasc Ther 11:184–190

    Article  PubMed  Google Scholar 

  36. Lee JT, Aziz IN, Lee JT et al (2003) Volume regression of abdominal aortic aneurysms and its relation to successful endoluminal exclusion. J Vasc Surg, 38:1254–1263

    Article  Google Scholar 

  37. Chaikof EL, Blankensteijn JD, Harris PL et al (2002) Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg 35:1048–1060

    Article  PubMed  Google Scholar 

  38. Veith FJ, Baum RA, Ohki T et al (2002) Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg 35:1029–1035

    Article  PubMed  Google Scholar 

  39. Maleux G, Koolen M, Heye S, Nevelsteen A (2008) Limb occlusion after endovascular repair of abdominal aortic aneurysms with supported endografts. J Vasc Interv Radiol 19:1409–1412

    Article  PubMed  Google Scholar 

  40. Gawenda M, Aleksic M, Heckenkamp J, Reichert V, Gossmann A, Brunkwall J (2007) Hybrid-procedures for the treatment of thoracoabdominal aortic aneurysms and dissections. Eur J Vasc Endovasc Surg 33:71–77

    Article  CAS  PubMed  Google Scholar 

  41. Schepens MA, Defauw JJ, Hamerlijnck RP, De Geest R, Vermeulen FE (1994) Surgical treatment of thoracoabdominal aortic aneurysms by simple crossclamping. Risk factors and late results. J Thorac Cardiovasc Surg 107:134–142

    CAS  Google Scholar 

  42. Burns P, Bradbury AW (2000) Duodenal obstruction following aortic aneurysm repair caused by an aneurysm sac seroma. Eur J Vasc Endovasc Surg 20:487–488

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Radiology, Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland

    Tobias Krauss, Thomas Pfammatter, Lukas Hechelhammer, Borut Marincek & Thomas Frauenfelder

  2. Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland

    Dieter Mayer & Mario Lachat

Authors
  1. Tobias Krauss
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Pfammatter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dieter Mayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mario Lachat
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lukas Hechelhammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Borut Marincek
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thomas Frauenfelder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Frauenfelder.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Krauss, T., Pfammatter, T., Mayer, D. et al. Hybrid-repair of thoraco-abdominal or juxtarenal aortic aneurysm: what the radiologist should know. Eur Radiol 20, 1011–1022 (2010). https://doi.org/10.1007/s00330-009-1603-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-009-1603-3

Keywords

Search

Navigation