Aortic anastomotic pseudoaneurysms: US, CT, MR, and angiography

Area of Science:

• Vascular Surgery
• Medical Imaging
• Radiology

Background:

• Postoperative complications following abdominal aortic graft prostheses can be challenging to detect.
• Aortic anastomotic pseudoaneurysms (AAPs) are a significant concern after these procedures.
• Comparing the efficacy of various imaging modalities is crucial for timely diagnosis and management.

Purpose of the Study:

• To correlate imaging findings with anatomic verification in patients with abdominal aortic graft prostheses.
• To compare the diagnostic value of angiography, CT, ultrasound, and MR in detecting postoperative complications, particularly AAPs.

Main Methods:

• Seven male patients with abdominal aortic graft prostheses underwent various imaging studies, including angiography, CT, ultrasound, and MR.
• Anatomic confirmation was achieved through surgery in six patients and autopsy in one.
• Imaging modalities were assessed for their ability to detect aortic anastomotic pseudoaneurysms and other abnormalities.

Main Results:

• Computed tomography (CT) correctly diagnosed all five aortic anastomotic pseudoaneurysms (AAPs) and one true abdominal aortic aneurysm.
• Digital subtraction angiography identified only one of five AAPs.
• Ultrasound and magnetic resonance (MR) showed variable accuracy in diagnosing AAPs, with MR performing better than ultrasound.

Conclusions:

• Computed tomography (CT) is the most effective imaging modality for diagnosing and evaluating aortic anastomotic pseudoaneurysms (AAPs) in patients with aortoiliofemoral graft prostheses.
• CT offers superior diagnostic performance compared to angiography, ultrasound, and MR for these specific complications.
• Accurate imaging is vital for managing postoperative complications after abdominal aortic grafting.