Using DynaCT for the assessment of ilio-femoral arterial calibre, calcification and tortuosity index in patients selected for trans-catheter aortic valve replacement


Adequate vascular access for femoral trans-catheter aortic valve replacement is fundamental to the success of the procedure. Assessment of vascular calibre, tortuosity and calcification is performed by angiography and multi-slice computed tomography (MSCT). Can DynaCT provide the same information as MSCT? 15 Patients underwent MSCT, angiography and DynaCT. Vessel diameter measurements were taken in three positions of the left and right ilio-femoral arteries. Tortuosity was assessed using an index of the direct distance and the distance taken by the artery between two points. Calcification was assessed in MSCT and DynaCT using a simple scoring system. Concordance correlation coefficient of arterial calibre between angiography and MSCT was 0.96 (95 % CI 0.94–0.97). DynaCT and angiography was 0.94 (95 % CI 0.91–0.96) and Dyna CT and MSCT, 0.95 (95 % CI 0.92–0.97). Bland–Altman tests demonstrate a mean difference between the angiogram and the MSCT of 0.06 mm (+0.97, −1.42), angiogram and DynaCT, 0.13 mm, (+1.00, −0.87), DynaCT and MSCT, 0.2 mm, (+1.15, −0.76). Tortuosity comparisons gave a median tortuosity index for MSCT 1.29 and DynaCT 1.23 (p = 0.472). Calcification comparisons of MSCT and DynaCT using correlation coefficients demonstrate a correlation of 0.245 (p = 0.378). Effective radiation doses were: DynaCT; 3.63 ± 0.65 mSv and angiography; 0.57 ± 0.72 mSv, MSCT; 7.15 ± 2.58 mSv. DynaCT is equal to MSCT and angiography in assessing femoral artery calibre. Like MSCT, it can assess tortuosity and can produce 3D images but is inferior in the assessment of calcification.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6


  1. 1.

    Leon M, Smith C, Mack M et al (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363(17):1597–1607

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG et al (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364(23):2187–2198

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Poon KK, Crowhurst J, James C, Campbell D, Roper D, Chan J, Incani A, Clarke A, Tesar P, Aroney C, Raffel OC, Walters DL (2012) Impact of optimising fluoroscopic implant angles on paravalvular regurgitation in transcatheter aortic valve replacements—utility of three-dimensional rotational angiography. EuroIntervention 8(5):538–545

    PubMed  Article  Google Scholar 

  4. 4.

    Nordon I, Hinchliffe R, Malkawi A, Taylor J (2010) Validation of DynaCT in the morphologic assessment of abdominal aortic aneurysm for endovascular repair. J Endovasc Ther 17(2):183–189

    PubMed  Article  Google Scholar 

  5. 5.

    ICRP (2007) Managing patient dose in multi-detector computed tomography (MDCT). ICRP Publication 102. Ann ICRP 37(1)

  6. 6.

    Thomas M, Schymik G, Walther T, Himbert D, Lefèvre T, Treede H, Eggebrecht H et al (2010) Thirty-day results of the SAPIEN aortic bioprosthesis European outcome (SOURCE) registry: a European registry of transcatheter aortic valve implantation using the edwards SAPIEN valve. Circulation 122:62–69

    PubMed  Article  Google Scholar 

  7. 7.

    Bullitt E, Zeng D, Gerig G, Aylward S, Joshi S, Smith JK, Lin W, Ewend MG (2005) Vessel tortuosity and brain tumor malignancy: a blinded study. Acad Radiol 12(10):1232–1240

    PubMed  Article  Google Scholar 

  8. 8.

    Nikolsky E, Mehran R, Turcot D, Aymong ED, Mintz GS, Lasic Z et al (2004) Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol 94:300–305

    PubMed  Article  Google Scholar 

  9. 9.

    Kahn JK, Rutherford BD, McConahay DR, Johnson WL, Giorgi LV, Shimshak TM et al (1990) High-dose contrast agent administration during complex coronary angioplasty. Am Heart J 120(3):533–536

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Bagur R, Webb JG, Fabian Nietlispach F, Dumont E et al (2010) Acute kidney injury following transcatheter aortic valve implantation: predictive factors, prognostic value, and comparison with surgical aortic valve replacement. Eur Heart J 31:865–874

    PubMed  Article  Google Scholar 

  11. 11.

    Ranucci M, Ballotta A, Kunkl A, De Benedetti D, Kandil H, Conti D et al (2008) Influence of the timing of cardiac catheterization and the amount of contrast media on acute renal failure after cardiac surgery. Am J Cardiol 101(8):1112–1118

    PubMed  Article  Google Scholar 

  12. 12.

    Nietlispach F, Leipsic J, Al-Bugami S, Masson J-B, Carere RG, Webb JG (2009) CT of the ilio-femoral arteries using direct aortic contrast injection: proof of feasibility in patients screened towards percutaneous aortic valve replacement. Swiss Med Wkly 139(31–32):458–462

    PubMed  Google Scholar 

  13. 13.

    Bai M, Liu B, Mu H, Liu X, Jiang Y (2012) The comparison of radiation dose between C-arm flat-detector CT (DynaCT) And multi-slice CT (MSCT): a phantom study. Eur J Radiol 81(11):3577–3580

    PubMed  Article  Google Scholar 

  14. 14.

    Onuma Y, Tanabe K, Nakazawa G, Aoki J, Nakajima H, Ibukuro K et al (2006) Noncardiac findings in cardiac imaging with multidetector computed tomography. J Am Coll Cardiol 18:415

    Google Scholar 

  15. 15.

    Gabriel M, Pawlaczyk K, Waliszewski K, Krasiński Z, Majewski W (2007) Location of femoral artery puncture site and the risk of postcatheterization pseudoaneurysm formation. Int J Cardiol 120(2):167–171

    PubMed  Article  Google Scholar 

  16. 16.

    Alonso M, Tascón J, Hernández F (2003) Complications with femoral access in cardiac catheterization. Impact of previous systematic femoral angiography and hemostasis with VasoSeal-Es® collagen. Rev Esp Cardiol 56(6):569–577

    PubMed  Google Scholar 

  17. 17.

    Banfić L, Vrkić Kirhmajer M, Vojković M, Strozzi M, Smalcelj A, Lasić Z (2008) Access site complications following cardiac catheterization assessed by duplex ultrasonography. Coll Antropol 32(2):385–390

    PubMed  Google Scholar 

Download references


JinLin Fu (MBBS PHD) for his work in providing statistical analysis for this paper.

Conflict of interest

The Prince Charles Hospital is involved in a research collaboration with Siemens Healthcare. Dr. Darren Walters is a consultant for Siemens, Medtronic Inc., a Proctor for Edwards Lifesciences and principal investigator for SOURCE ANZ registry. There are no other stock ownership, or other equity interests or patent-licensing arrangements within the article.

Author information



Corresponding author

Correspondence to James A. Crowhurst.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Crowhurst, J.A., Campbell, D., Raffel, O.C. et al. Using DynaCT for the assessment of ilio-femoral arterial calibre, calcification and tortuosity index in patients selected for trans-catheter aortic valve replacement. Int J Cardiovasc Imaging 29, 1537–1545 (2013).

Download citation


  • DynaCT
  • TAVR
  • Vessel calibre
  • Tortuosity
  • Calcification