Roberto Iezzi MD, Presenter: Nothing to Disclose

Carmine Di Stasi MD, Abstract Co-Author: Nothing to Disclose

Arianna Simeone, Abstract Co-Author: Nothing to Disclose

Alessandro Cina MD, Abstract Co-Author: Nothing to Disclose

Francesco Snider, Abstract Co-Author: Nothing to Disclose

Lorenzo Bonomo MD, Abstract Co-Author: Nothing to Disclose

To assess the clinical value and potential impact in the endograft treatment of the dynamic cine CT-Angiography of the proximal neck.  

Electrocardiographically-gated CTA datasets were acquired utilizing a 64-slice CT scanner (Light-Speed Volume CT, General Electric) on 30 consecutive pre-operative AAA patients. Pulsatility measurements were taken at 3 clinically relevant levels within the aneurysm neck: a) 2 cm above the highest renal artery, b) at the level of renal arteries, c) 1 cm below the lowest renal artery. Manual CTA measurements were performed on axial images twice by three independent readers in random order with at least a 4-week interval between readings. Aortic area and diameter changes were determined. On the basis of standard static axial images, one vascular surgeon and one interventional radiologist selected the size of the potential infrarenal stent-graft main body to implant (diameter available: 23, 26, 28.5, and 32mm). The size of the stent-graft main body diameter selected was compared to the dynamic measurements obtained.  

Significant aortic pulsatility exists within the aneurysm neck during the cardiac cycle. Proximal neck diameter significantly increased during the cardiac cycle with a maximum increase of up to 11.2%; in detail, when compared with dynamic measurements, the oversizing performed in the selection of stent-graft main body was inadequate in about 25% of patients. Furthermore, it was identified two different proximal neck dynamic patterns: aortic aneurysm with higher suprarenal pulsatility and aortic aneurysm with higher infrarenal pulsatility.  

Static CT imaging may not adequately size the stent-graft main body diameter due to aortic pulsatility, resulting in potential endograft undersizing, migration, type I endoleaks, and consequently poor patient outcomes. Dynamic CT imaging may also allow a correct selection of stent-graft in terms of fixation based on the aortic pulsatility pattern.  

Dynamic CT imaging may also allow a correct selection of stent-graft in terms of fixation based on the aortic pulsatility pattern.  

Iezzi, R, Di Stasi, C, Simeone, A, Cina, A, Snider, F, Bonomo, L, Dynamic Cine CT Angiography of the Proximal Aneurysm Neck: Conformational Changes during the Cardiac Cycle with Possible Consequences for Endograft Selection and Sizing.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8016045.html