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 Fattori, R. Articles by Gavelli, G. Search for Related Content PubMed PubMed Citation Articles by Fattori, R. Articles by Gavelli, G.

Descending Thoracic Aortic Diseases: Stent-Graft Repair¹

¹ From the Departments of Radiology (R.F., G.N., L.L., C.G., T.P., G.G.), Cardiology (G.R.), and Cardiovascular Surgery (E.A., R.D.B.), University Hospital S. Orsola, Via Massarenti 9, 40138 Bologna, Italy. Received July 19, 2002; revision requested August 27; final revision received February 15, 2003; accepted April 1. Address correspondence to R.F. (e-mail: ross@med.unibo.it).

View larger version (126K): [in a new window]   Figure 1a. Intraoperative DSA and follow-up CT images obtained in a 58-year-old man who underwent endovascular treatment for chronic type B dissection with dilatation of the false lumen. (a) Left anterior oblique preprocedure DSA image obtained to assess the aortic arch anatomy shows opacification of true (thin arrow) and false (thick arrow) lumina through a wide entry site. (b) Left anterior oblique DSA image obtained after stent-graft (arrow) deployment shows the correct positioning of stent-graft in the descending aorta. (c) Left anterior oblique postprocedure DSA image. After stent-graft placement, only the true lumen is evident, whereas the false lumen is not opacified. Left subclavian artery (arrow) is patent. (d) Oblique sagittal multiplanar reconstructed contrast-enhanced spiral CT image obtained at 6-month follow-up shows complete thrombosis of the false lumen (*).

View larger version (141K): [in a new window]   Figure 1b. Intraoperative DSA and follow-up CT images obtained in a 58-year-old man who underwent endovascular treatment for chronic type B dissection with dilatation of the false lumen. (a) Left anterior oblique preprocedure DSA image obtained to assess the aortic arch anatomy shows opacification of true (thin arrow) and false (thick arrow) lumina through a wide entry site. (b) Left anterior oblique DSA image obtained after stent-graft (arrow) deployment shows the correct positioning of stent-graft in the descending aorta. (c) Left anterior oblique postprocedure DSA image. After stent-graft placement, only the true lumen is evident, whereas the false lumen is not opacified. Left subclavian artery (arrow) is patent. (d) Oblique sagittal multiplanar reconstructed contrast-enhanced spiral CT image obtained at 6-month follow-up shows complete thrombosis of the false lumen (*).

View larger version (142K): [in a new window]   Figure 1c. Intraoperative DSA and follow-up CT images obtained in a 58-year-old man who underwent endovascular treatment for chronic type B dissection with dilatation of the false lumen. (a) Left anterior oblique preprocedure DSA image obtained to assess the aortic arch anatomy shows opacification of true (thin arrow) and false (thick arrow) lumina through a wide entry site. (b) Left anterior oblique DSA image obtained after stent-graft (arrow) deployment shows the correct positioning of stent-graft in the descending aorta. (c) Left anterior oblique postprocedure DSA image. After stent-graft placement, only the true lumen is evident, whereas the false lumen is not opacified. Left subclavian artery (arrow) is patent. (d) Oblique sagittal multiplanar reconstructed contrast-enhanced spiral CT image obtained at 6-month follow-up shows complete thrombosis of the false lumen (*).

View larger version (202K): [in a new window]   Figure 1d. Intraoperative DSA and follow-up CT images obtained in a 58-year-old man who underwent endovascular treatment for chronic type B dissection with dilatation of the false lumen. (a) Left anterior oblique preprocedure DSA image obtained to assess the aortic arch anatomy shows opacification of true (thin arrow) and false (thick arrow) lumina through a wide entry site. (b) Left anterior oblique DSA image obtained after stent-graft (arrow) deployment shows the correct positioning of stent-graft in the descending aorta. (c) Left anterior oblique postprocedure DSA image. After stent-graft placement, only the true lumen is evident, whereas the false lumen is not opacified. Left subclavian artery (arrow) is patent. (d) Oblique sagittal multiplanar reconstructed contrast-enhanced spiral CT image obtained at 6-month follow-up shows complete thrombosis of the false lumen (*).

View larger version (164K): [in a new window]   Figure 2a. Left anterior oblique DSA images obtained in a 72-year-old man who underwent endovascular treatment for penetrating ulcers of descending thoracic aorta. (a) Preprocedure DSA image shows multiple ulcers (arrows) of the descending thoracic aorta. (b) Postprocedure DSA image demonstrates complete exclusion of the penetrating ulcers.

View larger version (146K): [in a new window]   Figure 2b. Left anterior oblique DSA images obtained in a 72-year-old man who underwent endovascular treatment for penetrating ulcers of descending thoracic aorta. (a) Preprocedure DSA image shows multiple ulcers (arrows) of the descending thoracic aorta. (b) Postprocedure DSA image demonstrates complete exclusion of the penetrating ulcers.

View larger version (181K): [in a new window]   Figure 3a. MR images obtained at 1-year follow-up in a 64-year-old man treated for thoracic atherosclerotic aneurysm who had persistent postinflammation syndrome and severe back pain. (a) Transverse nonenhanced T1-weighted fast spin-echo image (1,411/23.4) shows intense signal of aortic thrombus. (b) Transverse nonenhanced T2-weighted fast spin-echo image (2,105/101) shows severe thickening of adventitial wall (arrows) with heterogeneous signal intensity of the thrombus. (c) Transverse contrast-enhanced T1-weighted fast spin-echo image (1,846/4.6) obtained after gadolinium-based contrast medium administration shows homogeneous enhancement of the thrombus (*), a finding that is consistent with inflammatory response.

View larger version (178K): [in a new window]   Figure 3b. MR images obtained at 1-year follow-up in a 64-year-old man treated for thoracic atherosclerotic aneurysm who had persistent postinflammation syndrome and severe back pain. (a) Transverse nonenhanced T1-weighted fast spin-echo image (1,411/23.4) shows intense signal of aortic thrombus. (b) Transverse nonenhanced T2-weighted fast spin-echo image (2,105/101) shows severe thickening of adventitial wall (arrows) with heterogeneous signal intensity of the thrombus. (c) Transverse contrast-enhanced T1-weighted fast spin-echo image (1,846/4.6) obtained after gadolinium-based contrast medium administration shows homogeneous enhancement of the thrombus (*), a finding that is consistent with inflammatory response.

View larger version (177K): [in a new window]   Figure 3c. MR images obtained at 1-year follow-up in a 64-year-old man treated for thoracic atherosclerotic aneurysm who had persistent postinflammation syndrome and severe back pain. (a) Transverse nonenhanced T1-weighted fast spin-echo image (1,411/23.4) shows intense signal of aortic thrombus. (b) Transverse nonenhanced T2-weighted fast spin-echo image (2,105/101) shows severe thickening of adventitial wall (arrows) with heterogeneous signal intensity of the thrombus. (c) Transverse contrast-enhanced T1-weighted fast spin-echo image (1,846/4.6) obtained after gadolinium-based contrast medium administration shows homogeneous enhancement of the thrombus (*), a finding that is consistent with inflammatory response.

View larger version (166K): [in a new window]   Figure 4a. Oblique sagittal contrast-enhanced MR angiograms obtained in a 45-year-old woman treated for chronic type B dissection with refractory hypertension. (a) Three-dimensional spoiled gradient-echo MR angiographic image (5.6/1.4) obtained before treatment shows type B dissection involving abdominal aorta with dilatation of the patent false lumen (*) in the thoracic aorta. (b) Three-dimensional spoiled gradient-echo MR angiographic image (4.2/1.3) obtained at 12-month follow-up shows complete thrombosis and shrinkage of the false lumen in the thoracic aorta. Metal artifacts (arrows) are caused by nitinol wires of stent-graft.

View larger version (168K): [in a new window]   Figure 4b. Oblique sagittal contrast-enhanced MR angiograms obtained in a 45-year-old woman treated for chronic type B dissection with refractory hypertension. (a) Three-dimensional spoiled gradient-echo MR angiographic image (5.6/1.4) obtained before treatment shows type B dissection involving abdominal aorta with dilatation of the patent false lumen (*) in the thoracic aorta. (b) Three-dimensional spoiled gradient-echo MR angiographic image (4.2/1.3) obtained at 12-month follow-up shows complete thrombosis and shrinkage of the false lumen in the thoracic aorta. Metal artifacts (arrows) are caused by nitinol wires of stent-graft.

View larger version (16K): [in a new window]   Figure 5. Graph shows leakage-free survival curve of 68 patients treated with stent-graft.

View larger version (15K): [in a new window]   Figure 6. Graph shows survival curve of 68 patients treated with stent-graft.