Aneurysms angiography

Engellau L, Albrechtsson U, Hojgard S, et al. Costs in followup of endovascularly repaired abdominal aortic aneurysms. Magnetic resonance imaging with MR angiography versus EUROSXAR protocols, Int Angiol 2003 22( I ) 36—42. 

Alternatively, 3D images of MR angiographies can be calculated using volume rendering techniques (VRT) or shaded surface display (SSD). Both methods, however, depend on threshold values and therefore they carry the risk of unwanted manipulation. They are less suitable for the depiction of stenoses and are commonly used for aneurysms and other vascular malformations. 

A 31-year-old woman suddenly developed central chest pain, with a normal electrocardiogram. Changes in troponin and creatine kinase MB were consistent with acute myocardial infarction. Drug screening was positive for amphetamines and barbiturates. Coronary angiography showed an aneurysm with 99% occlusion of the proximal left circumflex coronary artery and extravasation of contrast material. A stent was inserted percutaneously and antegrade flow was achieved without residual stenosis. 

Chappell ET, Moure FC, Good MC (2003). Comparison of computed tomographic angiography with digital subtraction angiography in the diagnosis of cerebral aneurysms a meta-analysis. Neurosurgery 52 624-631... 

Raaymakers TW (1999). Aneurysms in relatives of patients with subarachnoid hemorrhage frequency and risk factors. MARS Study Group. Magnetic Resonance Angiography in Relatives of patients with subarachnoid hemorrhage. Neurology 53 982-988... 

Wintermark M, Uske A, Chalaron M et al. (2003). Multislice computerized tomography angiography in the evaluation of intracranial aneurysms a comparison with intraarterial digital subtraction angiography. Journal of Neurosurgery 98 828-836... 

Erdem, C.Z., Erdem, L.O., Comert, M., Ustnndag, Y., Gundogu, S. Multiple intra-hepatic portal vein aneurysms — findings on magnetic resonance angiography. Clin. Radiol. 2003 58 899—901... 

Slaba SG, El-Hajj LF, Abboud GA, Gebara VA. Selective angiography of cerebral aneurysm using gadodiamide in polycystic kidney disease with renal insufficiency. AJR Am J Roentgenol 2000 175(5) 1467-8. 

In contrast to angiography, IVUS provides quantitative information from within the vessel on diameter, circumference, luminal diameter, plaque volume, and percent stenosis. Qualitative information regarding the amount of plaque elevation, plaque composition (e.g., calcific, fibrous, or fatty plaque), and the presence of plaque versus thrombus, thrombus versus tumor, and aneurysm and hematoma can be provided with IVUS. IVUS is also used as a therapeutic adjunct with PTCA, atherectomy, stent or graft placement, and fibrinolysis, although routine use may not be justified. These combination procedures may be monitored in real time as the procedure (e.g., atherectomy) is being performed. 

Vieco PT, Morin EE 111, Gross CE (1996) CT angiography in the examination of patients with aneurysm clips. Am J Neuroradiol 17(3) 455 57. 

If after this, an aneurysm, diagnosed at CT, is not found or fills slowly from no named artery at superselective angiography, do not assume that that the CT scan is incorrect, that the aneurysm does not exist or is unimportant Check the angiogram for areas of arterial spasm (Fig. 7.2) and if not found, consider percutaneous CT or ultrasound guided autologous thromhin injection. 

Post embolization, immediate check angiography is indicated. It is important to perform pre and post contrast enhanced CT initially as the aneurysm will still contain contrast from the initial embolization for up to 4 weeks post procedure (Fig. 7.5d). Further CECT scans at 24 h, 1 week, 1 month and 3 months are indicated. CECT should also be performed anytime where there is recurrent pain or haematemesis. 

If the aneurysm does recur, repeat angiography and embolization is indicated if there is still access and recanalization or recruitment of other arteries has occurred. CT guided percutaneous thrombin may also be used but it may be that open surgery is the only alternative. See Table 7.1 for details of technical requirements. 

Fig.7.9a,b. A 52-year-old woman with a recent history of gall stone pancreatitis was admitted with further abdominal pain. A CECT scan suggested an aneurysm of uncertain origin. Angiography revealed a true (Type la) aneurysm of an aberrant right hepatic artery (a). CECT had revealed a patent portal vein and so proximal and distal coil embolization was performed (b). There were no further complications and the patient is alive and well at 36 months... 

The author has used percutaneous CT guided thrombin injection in six patients where pancreatitis associated aneurysms could not be seen at selective angiography. The technique is relatively simple, the aneurysm being punctured with a 21-Gauge saline flushed needle under CT guidance... 

Aneurysms and pseudoaneurysms causing haemobilia or associated with pancreatitis are potentially fatal. Imaging, particularly CECT, is vital to their diagnosis. Conservative therapy is a poor option and treatment, which was formally via open surgery, is now best carried out by angiography and percutaneous coil embolization in haemobilia and for Type la and b pancreatitis associated pseudoaneurysms. Percutaneous CT guided thrombin therapy is indicated for Type 2 aneurysms. 

Gorich J, Rilinger N, Kramer S, et al (2000) Angiography of leaks after endovascular repair of infrarenal aortic aneurysms. AJR Am J Roentgenol 174 811-814... 

Wolf YG, Johnson BL, Hill BB, et al (2000) Duplex ultrasound scanning versus computed tomographic angiography for post-operative evaluation of endovascular abdominal aortic aneurysm repair. J Vase Surg 32 1142-8... 

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