Extended use of computed tomography in the management of complex aortic problems: a learning experience

Eighty-nine patients with clinical problems arising from the thoracic or abdominal aorta had computed tomography (CT) scans with contrast enhancement in addition to standard aortograms. Forty-four patients had aneurysms, 22 had aortic graft complications, and 23 had aortoiliac occlusion. CT scanning provided diagnostic information not apparent by conventional angiography in 39 patients (43.8%). This additional information did not significantly alter the operative management in 13 patients (14.6%). The helpful information provided by CT in these patients included demonstration of gallstones, renal cysts, anomalous venous structures, horseshoe kidney, and femoral anastomotic aneurysms. However, in 26 of 89 patients (29%), the additional data obtained by CT significantly changed the timing or approach to operative management. Management was altered in 12 of 44 patients (28%) with aneurysms, 7 of 22 patients (32%) with aortic graft complications, and 7 of 23 patients (30%) with aortoiliac occlusive disease or suspected distal thromboembolism. Specific information provided by CT included contained aortic aneurysm rupture, aortic dissection, laminated intraluminal thrombus or pseudointima, extent of perigraft infection, aortic atherosclerosis, anastomotic false aneurysm, and thrombus as a source of distal embolization. Thus, CT had a significant impact on operative management. It serves as a valuable adjunct to aortography in patients with complex aortic problems.