Paul Cronin, MD, MS, Gilbert R. Upchurch, MD, Himanshu J. Patel, MD, G

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Presentation transcript:

Asymmetric expansion of aortic aneurysms on computed tomography imaging Paul Cronin, MD, MS, Gilbert R. Upchurch, MD, Himanshu J. Patel, MD, G. Michael Deeb, MD, Aine Marie Kelly, MD, MS, David M. Williams, MD Journal of Vascular Surgery Volume 57, Issue 2, Pages 390-398.e3 (February 2013) DOI: 10.1016/j.jvs.2012.08.044 Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 1 Intravenous contrast material-enhanced computed tomographic scans. A, Lower thoracic aorta in a control subject. Note the normal-caliber aorta and the short interbranch arc length (ie, the arc length between the arterial origins of each paired intercostal artery; black arrow). B, Thoracic aorta in a patient with an aortic aneurysm. Note the increased diameter of the thoracic aorta but the relatively preserved short interbranch arc length (ie, the arc length between the arterial origins of each paired intercostal artery; black arrow). C, Abdominal aorta in a patient with an aortic aneurysm at the level of the celiac axis. Again, note the increased diameter of the abdominal aorta but the relatively preserved short interbranch arc length (ie, the arc length between the arterial origins of each paired lumbar artery; black arrow). Journal of Vascular Surgery 2013 57, 390-398.e3DOI: (10.1016/j.jvs.2012.08.044) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 2 Representation of interbranch arc length and remainder of the aortic circumference length. On each slice containing an intercostal or lumbar artery, the arc length between the arterial origins (interbranch arc length) of each paired artery was measured (orange arrow) and the vertebral body level noted. The aortic circumference was measured and the interbranch arc length subtracted, giving the remainder of the aortic circumference length (blue arrow). The residual ratio (ie, the ratio of interbranch arc length to the remainder of aortic circumference) was calculated at each level where an aneurysm was present, from T4 to L4 for each patient. Journal of Vascular Surgery 2013 57, 390-398.e3DOI: (10.1016/j.jvs.2012.08.044) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Arc length between posterior paired branch vessels of the total aneurysm patients compared with that of control subjects, at each vertebral body level from T4 to L4. Arc length between posterior paired branch vessels (interbranch arc length) of aneurysmal aortas is larger at each vertebral level compared with controls (P < .05). The differences were statistically significant only at T4 and from T8 to L4. B, Residual aortic circumference lengths of total aneurysm patients compared with control subjects, at each vertebral body level from T4 to L4. The circumference of the aneurysmal aortas is larger compared with that of controls at each vertebral level, and the differences were statistically significant at all vertebral levels. C, Comparison between interbranch arc length to residual aortic circumference ratio of total aneurysm patients compared with that of control subjects, at each vertebral body level from T4 to L4. The aortic posterior branch arc length to residual aortic circumference ratio is reduced compared with that of controls at each vertebral level and was significantly different (P < .05) at all vertebral body levels from T4 to L4, except at the L4 levels. Journal of Vascular Surgery 2013 57, 390-398.e3DOI: (10.1016/j.jvs.2012.08.044) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 4 Comparison of interbranch arc length to residual aortic circumference ratio of thoracic aneurysm patients compared with that of control subjects, at each vertebral body level from T4 to T12. The aortic posterior branch arc length to residual aortic circumference ratio is reduced compared with that of controls at each vertebral level, and the differences were statistically significant (P < .05) at all vertebral body levels from T4 to T12, except at the T11 level. Journal of Vascular Surgery 2013 57, 390-398.e3DOI: (10.1016/j.jvs.2012.08.044) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 5 Comparison of interbranch arc length to residual aortic circumference ratio of thoracicoabdominal aneurysm patients compared with that of control subjects, at each vertebral body level from T4 to L4. The aortic posterior branch arc length to residual aortic circumference ratio is reduced compared with that of controls at each vertebral level, and the differences were statistically significant (P < .05) at all vertebral body levels from T4 to L4, except at the L4 levels. Journal of Vascular Surgery 2013 57, 390-398.e3DOI: (10.1016/j.jvs.2012.08.044) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 6 Comparison of interbranch arc length to residual aortic circumference ratio of abdominal aneurysm patients compared with that of control subjects, at each vertebral body level from L1 to L4. The aortic posterior branch arc length to residual aortic circumference ratio is reduced compared with that of controls at each vertebral level, and the differences were statistically significant (P < .05) at all vertebral body levels from L1 to L4, except at the L4 levels. Journal of Vascular Surgery 2013 57, 390-398.e3DOI: (10.1016/j.jvs.2012.08.044) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 7 Lumbar arteries in a patient with chronic dissection. The intercostal/lumbar arteries do not seem to tether the false lumen of a chronic dissection and prevent or mitigate aneurysmal growth. Journal of Vascular Surgery 2013 57, 390-398.e3DOI: (10.1016/j.jvs.2012.08.044) Copyright © 2013 Society for Vascular Surgery Terms and Conditions

Fig 8 A 14-day-old type B dissection. A, Paired intercostal arteries. B, The flap is reflected along the line of dissection. There is migration of the intercostal artery origins from holes on the flap, which shows acute expansion of the false lumen. The second zone of expansion is marked by the black arrows. C, Magnified portion of the image outlined by the black box in B. Separation of true lumen (black arrows) and false lumen (arrowheads) intercostal artery origins is shown in an unfixed specimen. Journal of Vascular Surgery 2013 57, 390-398.e3DOI: (10.1016/j.jvs.2012.08.044) Copyright © 2013 Society for Vascular Surgery Terms and Conditions