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Evaluation of patients with thoracic aortic dissection by intraarterial digital subtraction angiography
J Andresen1, N Baekgaard, H Allermand
1Department of Radiology Skejby Hospital, University of Aarhus, Denmark.
Insights
Intraarterial digital subtraction angiography precisely visualizes thoracic aortic dissection, detailing true and false lumens and intimal flaps. This imaging aids in surgical decision-making for dissections involving major arteries.
Area of Science:
- Cardiovascular Imaging
- Vascular Surgery
Background:
- Thoracic aortic dissection is a life-threatening condition requiring accurate diagnosis.
- Conventional imaging may not fully delineate the complex anatomy of aortic dissection.
Purpose of the Study:
- To evaluate the utility of intraarterial digital subtraction angiography (IDSA) in diagnosing thoracic aortic dissection.
- To assess the capability of IDSA in visualizing the extent, lumens, and intimal flap of aortic dissections.
Main Methods:
- IDSA was performed in 17 patients with suspected thoracic aortic dissection.
- Detailed analysis of images to identify proximal and distal extent, true/false lumens, intimal flap, and entry/reentry points.
Main Results:
- IDSA accurately delineated the proximal and distal extent of dissection in all patients.
- Visualization of true and false lumens, intimal flap, and blood flow direction was achieved.
- Entry and reentry points were identified with varying clarity; involvement of aortic branches was noted.
Conclusions:
- IDSA provides precise anatomical and pathophysiological information for thoracic aortic dissection.
- This detailed imaging facilitates informed decisions regarding surgical intervention and operative strategy.
Abstract:
In 17 patients (mean age 60 years) a thoracic aortic dissection could be revealed by intraarterial digital subtraction angiography with exact delineatin of the proximal and distal extent. Furthermore a visualisation of the true and false lumen and hereby especially the blood flow and its direction in the false lumen could be made. The disclosure of the intimal flap could be seen in patients with flow in both channels, separating the true and the false lumen. In 4 patients the entry could be seen sharply as a hole, but not corresponding to the proximal extent. In 11 patients the entry was seen over a longer area and in 2 patients neither entry nor reentry could be seen. The most distal part of the intimal flap might correspond to the reentry. One anonymous artery, five renal arteries and one coeliac trunc were involved by the dissection. The exact anatomical and pathophysiological nature of the dissection made it possible to decide whether or not the patients should be operated upon and if so, what kind of operation should be chosen.