Efficacy of transcatheter arterial embolization in treating nonvariceal gastric remnant bleeding: a retrospective 5-year study.

BACKGROUND: Gastric remnant bleeding is a special case of upper gastrointestinal bleeding with certain specific disease characteristics, and some matters of transcatheter arterial embolization (TAE) for hemostasis need attention. In this study, we aimed to explore the clinical use of TAE in patients with nonvariceal gastric remnant bleeding and identify the factors influencing the clinical efficacy of these interventions. METHODS: Data were retrospectively analyzed from 42 patients for whom angiography and embolization were performed but could not be treated endoscopically or had failed endoscopic management in our department between January 2018 and January 2023 due to nonvariceal gastric remnant bleeding. We investigated the relationship between the incidence of re-bleeding and the following variables: sex, age, pre-embolization gastroscopy/contrast-enhanced computer tomography, embolization method, aortography performance, use of endoscopic titanium clips, and the presence of collateral gastric-supplying arteries. RESULTS: Forty-two patients underwent 47 interventional embolizations. Of these, 16 were positive for angiographic findings, and 26 were negative. Based on arteriography results, different embolic agents were selected, and the technical success rate was 100%. The incidence of postoperative re-bleeding was 19.1% (9/47), and the overall clinical success rate was 81.0% (34/42). Logistic regression analysis of the relationship between the incidence of early re-bleeding following embolization and the proportion of collateral gastric supply arteries revealed an odds ratio of 10.000 (p = 0.014). CONCLUSIONS: Utilizing TAE for nonvariceal gastric remnant bleeding is safe and effective. The omission of collateral gastric-supplying arteries can lead to early re-bleeding following an intervention.

Feasibility study of a synchronized diastolic injection with low contrast volume for proper quantitative assessment of aortic regurgitation in porcine models.

OBJECTIVES: To evaluate the in vivo feasibility of aortography with one accurately timed diastolic low-volume contrast injection for quantitative assessment of aortic regurgitation (AR) post transcatheter aortic valve replacement (TAVR). BACKGROUND: With the rise of a minimalistic approach for TAVR, aortography (re)emerges as a pragmatic tool for AR assessment. In a mock circulation system, we have validated the accuracy of a single diastolic injection triggered by electrocardiogram (ECG) with low-contrast volume. METHODS: Two-phase experiment: first, a series of aortograms were performed in a porcine model, with 8 mL of contrast using the synchronized (SYNC) and the conventional non-synchronized (NS) injections. In a second phase, we developed a model of AR by inserting partially unsheathed Wallstents of 6-10 mm of diameter across the pig's aortic valve, performing SYNC injections with 8 mL of contrast and NS injections with 8 mL and 15 mL (rate: 20 mL/sec). Respective accuracies of SYNC vs. NS were assessed using Passing-Bablock regression. An angiography core laboratory performed quantitative AR assessment with videodensitometry (VD-AR). RESULTS: The SYNC injections produced higher opacification of the aortic root compared with NS injections (P = 0.04 for density). In the second phase, a regression line for predicting VD-AR based on the SYNC injection resulted in a lower intercept and a slope closer to the line of identity (y = 11.9 + 0.79x, P < 0.001, r2 = 0.94) with the NS-8 mL than with the NS-15 mL injection (y = 26.5 + 0.55x, P < 0.001, r2 = 0.81). CONCLUSION: Synchronized diastolic injection with low contrast volume produced denser images in the aortic root and more accurate than the conventional injection; thus, may be an appealing alternative for assessment of AR post TAVR.

Balloon Valvuloplasty to Predict X-ray Projection Angles that are Perpendicular to Cardiovascular Structures: A TAVI Patient Feasibility Study.

OBJECTIVES: The purpose of this work is to describe methods to measure the 3D angular orientation of cardiovascular structures based on a planar image of a valvuloplasty balloon. These methods facilitate X-ray beam alignment with respect to the anatomy of interest. BACKGROUND: X-ray beam projections which are perpendicular to the long axis of cardiovascular structures are required to support interventional procedures, including transcatheter aortic valve implant (TAVI). METHODS: During the TAVI procedure, the 3D angular orientation of the LVOT of 10 patients was measured from a single planar image of an aortic valvuloplasty balloon and the continuous range of X-ray projection angles which are aligned with the aortic valve plane were calculated (research method). Misalignment of the X-ray beam and TAVI valve frame was measured from images of the deployed valve. The accuracy of the research method was compared to clinical standard method to determine appropriate X-ray projection angles, which utilized CT and aortography. RESULTS: Using the clinical standard method, the median misalignment of the X-ray beam and TAVI valve frame was 8.6° (range 2.6° to 21°). Misalignment was reduced to 2.5° (range 0° to 10°) using the research method. CONCLUSIONS: The 3D angular orientation of cardiovascular structures can be measured accurately from a single X-ray projection image of a known cardiovascular device contained within the anatomy of interest. For TAVI procedures, improved X-ray beam alignment may help facilitate procedural success. © 2016 Wiley Periodicals, Inc.

Contrast volume reduction using third generation dual source computed tomography for the evaluation of patients prior to transcatheter aortic valve implantation.

OBJECTIVES: Chronic renal failure is common in patients referred for transcatheter aortic valve implantation (TAVI). CT angiography is recommended and provides crucial information prior to TAVI. We evaluated the feasibility of a reduced contrast volume protocol for pre-procedural CT imaging. METHODS: Forty consecutive patients were examined with prospectively ECG-triggered high-pitch spiral acquisition using a novel third-generation dual-source CT system; 38 ml contrast agent was used. Image quality was graded on a visual scale (1-4). Contrast attenuation was measured at the level of the aortic root and at the iliac bifurcation. RESULTS: Mean patient age was 82 ± 6 years (23 males; 58 %). Mean attenuation/average image quality was 285 ± 60 HU/1.5 at the aortic annulus compared to 289 ± 74 HU/1.8 at the iliac bifurcation (p = 0.77/p = 0.29). Mean estimated effective radiation dose was 2.9 ± 0.3 mSv. A repeat acquisition was necessary in one patient due to image quality. Out of the 35 patients who underwent TAVI, 31 (89 %) patients had no or mild aortic regurgitation. Thirty-two (91 %) patients were discharged successfully. CONCLUSION: Pre-procedural CTA with a total of 38 ml contrast volume is feasible and clinically useful, using third-generation dual-source CT, allowing comprehensive imaging for procedural success. KEY POINTS: • Reduction of contrast agent volume is crucial in patients with chronic renal failure. • Novel third-generation computed tomography helps to reduce contrast agent volume. • Pre-procedural CT allows comprehensive imaging for procedural success before heart valve implantation. • A low-contrast CT protocol is feasible for pre-procedural TAVI planning.

Trans-pulmonary echocardiography as a guide for device closure of patent ductus arteriosus.

OBJECTIVES: The aim of this study was to develop trans-pulmonary echocardiography (TPE) to guide device closure of patent ductus arteriosus (DC-PDA). BACKGROUND: Aortography requires a large amount of contrast yet may give us an inadequate image to evaluate anatomy or residual shunt in patients with large PDA or dilated vessels and is precluded in patients with renal dysfunction. Practically, there is no imaging modality to monitor the entire procedure except for trans-esophageal echocardiography that requires general anesthesia. METHODS: Subjects were seven patients with ages ranged from 6- to 77-years old and body weight > 15 kg. The size of the PDA ranged from 1.8 to 6.3 mm with pulmonary to systemic flow ratios from 1.2 to 2.2. During DC-PDA using Ampaltzer Duct Occluder or coil, an intra-cardiac echocardiographic (ICE) catheter was advanced into pulmonary arteries and standard views were developed to guide DC-PDA. RESULTS: We have developed two standard views; the main pulmonary artery view (MPA view) and the left pulmonary artery view (LPA view). The MPA view provided aortic short axis view equivalent to that seen by trans-thoracic echocardiography in children. The LPA view, obtained by the echo probe in the LPA and turned it up upside down, provided long axis view of the PDA allowing more precise anatomical evaluation. TPE allowed us to monitor the entire procedure and determine residual shunts. CONCLUSIONS: TPE in the MPA and LPA view can be an effective guide for DC-PDA. This report leads to new application of this imaging device.

Basic Overview of Conventional Coronary Angiography for Planning Cardiac Surgery.

Coronary angiography is a common procedure performed by the cardiologist to evaluate coronary atherosclerotic disease (CAD) and the result is utilized by both cardiologists and cardiac surgeons to perform catheter and surgical interventions on the coronary artery. In addition to evaluating CAD, other useful investigative modalities such as left ventriculography and aortography can be performed at the time of coronary angiography. Despite its limitations and the emergence of newer investigative modalities like coronary computed tomography angiography, intravascular ultrasound scan, and magnetic resonance coronary angiography, conventional coronary angiography has remained the gold standard for the evaluation of coronary artery disease. Hence, it remains an investigative modality that every member of the cardiothoracic team performing coronary artery bypass grafting must learn how to interpret.

Endovascular Simulator Training and Shadowing in Interventional Radiology: A Comparison of Two Teaching Methods in the Curricular Training of Medical Students.

PURPOSE: To identify the impact of endovascular simulator training and shadowing in interventional radiology on medical students' self-assessed IR knowledge. Moreover, the sequence of the teaching methods and its influence on the self-assessed IR knowledge is investigated. MATERIALS AND METHODS: A total of 19 fourth-year medical students participated in this study. Eleven students completed shadowing live cases first and endovascular simulator training the following day. Eight students completed the teaching in reversed order. Questionnaires were completed before and after each teaching method. The students assessed their knowledge of instruments and materials, steps of the Seldinger technique, and aortography on a Likert scale (1 = "I do not agree at all," 5 = "I fully agree"). RESULTS: After simulator training, the students stated a significant increase in perceived knowledge compared with baseline (p < 0.001). Shadowing led to a significant improvement regarding the items "knowledge of instruments and materials" (3.2 vs. 3.8, p = 0.008) and "steps of the Seldinger technique" (3.7 vs. 3.9, p = 0.046). Self-assessed knowledge after simulator training increased significantly more regarding Seldinger technique compared with shadowing (+ 1.2 vs. + 0.2, p < 0.001). Simulator training before shadowing was significantly more effective regarding the increase in "knowledge of the steps of aortography" compared with the reverse sequence (+ 2.0 vs. + 0.9, p = 0.041). CONCLUSION: Endovascular simulator training and shadowing are both feasible tools to improve medical students' perceived knowledge of interventional radiology. When organizing teaching, simulator training before shadowing can have a positive impact on self-assessed knowledge.

Use of ultra-low contrast dose CT aortography for the management of aortic aneurysmal disease.

PURPOSE: Computed tomography aortography (CTA) is used in the assessment of aortic pathologies and planning of surgical intervention. However, its dependence on iodinated contrast can result in development of contrast-induced acute kidney injury (CI-AKI). The potential concern of CI-AKI has spurred research into the potential of administration of low contrast volumes in CTA investigations while maintaining overall diagnostic appeal. Several studies have shown that CTA using contrast volumes as low as 30 mL (equivalent to 10.5 g of iodine) can still yield scans of diagnostic quality. We present a retrospective pilot study to evaluate the feasibility of utilising an ultra-low volume of iodinated intravenous contrast in a population of patients with severe renal insufficiency with referral from our vascular surgery unit for CTA evaluation of the thoracic and abdominal aorta. METHODS: This retrospective pilot study examined 12 CTA scans performed with 20 mLs of iodinated contrast and assessed image quality with both quantitative and qualitative markers. All scans were performed on a Siemens SOMATOM Force dual-source CT scanner. Quantitative assessment values were measured via attenuation values at eight aortoiliac locations and used to calculate a signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at each location. Qualitative analysis of image quality and viability for surgical intervention was obtained from subjective clinical assessment by an interventional radiologist and vascular surgeon. RESULTS: Obtained quantitative assessment values included mean attenuation 189.9 HU, mean SNR 9.6 and mean CNR 8.0. All 12 scans demonstrated individual mean SNR values above predetermined quality thresholds while only five scans produced individual mean CNR values above threshold. Eleven of 12 scans were determined to be of sufficient quality for diagnosis and planning of surgical intervention. CONCLUSIONS: Our results suggest that CTA utilising an ultra-low contrast dose of 20 mLs (6 g iodine) yields scans of diagnostic quality for therapeutic decision-making in vascular surgical intervention.

The Role of Multimodality Imaging Approach in Acute Aortic Syndromes: Diagnosis, Complications, and Clinical Management.

Acute aortic syndromes are life-threatening conditions with high morbidity and mortality. The principal pathological feature is acute wall damage with possible evolution towards aortic rupture. Accurate and timely diagnosis is mandatory to avoid catastrophic consequences. Indeed, misdiagnosis with other conditions mimicking acute aortic syndromes is associated with premature death. In this view, cardiovascular imaging is necessary for the correct diagnosis and management. Echocardiography, computed tomography, magnetic resonance imaging, and aortography allow for diagnosis, guarantee immediate treatment, and detect associated complications. Multimodality imaging is essential in the diagnostic work-up to confirm or rule out acute aortic syndromes. The aim of this review is to highlight the contemporary evidence on the role of single cardiovascular imaging techniques and multimodality imaging in the diagnosis and management of acute aortic syndromes.

Takayasu Arteritis in the Pre-Pulseless Phase Presenting as Pyrexia of Unknown Origin.

Pyrexia of unknown origin (PUO) or fever of unknown origin (FUO) is clinically challenging for a treating physician; it is also a conundrum for the patient until a definitive diagnosis is made. Despite extensive investigations, many cases of PUO may remain undiagnosed for a long time. In a resource-limited country like India, due to the limited availability of various diagnostic tests, a great many fever cases are classified as PUO. Here, we present a case report of Takayasu arteritis in its pre-pulseless phase, presented as PUO. Takayasu arteritis presenting as PUO in the absence of a pulse deficit is uncommon and rarely reported. The patient's fever responded to steroids with methotrexate. The patient didn't develop any vascular complications during the follow-up.

Coronary Calcium Predicts All-Cause Mortality in Suspected Acute Aortic Syndrome.

Purpose: To determine long-term clinical outcomes in patients with suspected acute aortic syndrome (AAS) and evaluate the prognostic value of coronary calcium burden as assessed with CT aortography in this symptomatic population. Materials and Methods: A retrospective cohort of all patients who underwent emergency CT aortography from January 2007 through January 2012 for suspected AAS was assembled. A medical record survey tool was used to evaluate subsequent clinical events over 10 years of follow-up. Events included death, aortic dissection, myocardial infarction, cerebrovascular accident, and pulmonary embolism. Coronary calcium scores were computed from original images using a validated simple 12-point ordinal method and categorized into none, low (1-3), moderate (4-6), or high (7-12) groupings. Survival analysis with Kaplan-Meier curves and Cox proportional hazard modeling was performed. Results: The study cohort comprised 1658 patients (mean age, 60 years ± 16 [SD]; 944 women), with 595 (35.9%) developing a clinical event over a median follow-up of 6.9 years. Patients with high coronary calcium demonstrated the highest mortality rate (adjusted hazard ratio = 2.36; 95% CI: 1.65, 3.37). Patients with low coronary calcium demonstrated lower mortality, but rates were still almost twice as high compared with patients with no detectable calcium (adjusted hazard ratio = 1.89; 95% CI: 1.41, 2.53). Coronary calcium was a strong predictor of major adverse cardiovascular events (P < .001), which persisted after adjustment for common significant comorbidities. Conclusion: Patients with suspected AAS had a high rate of subsequent clinical events, including death. CT aortography-based coronary calcium scores strongly and independently predicted all-cause mortality.Keywords: Acute Aortic Syndrome, Coronary Artery Calcium, CT Aortography, Major Adverse Cardiovascular Events, Mortality Supplemental material is available for this article. © RSNA, 2023See also commentary by Weir-McCall and Shambrook in this issue.

Quantitative aortography for assessment of aortic regurgitation in the era of percutaneous aortic valve replacement.

Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models. In the clinical setting, LVOT-AR was compared with trans-thoracic and trans-oesophageal echocardiography and cardiac magnetic resonance imaging. LVOT-AR > 17% discriminates mild from moderate aortic regurgitation on echocardiography and confers a poor prognosis in multiple registries, and justifies balloon post-dilatation. The LVOT-AR differentiates the individual performances of many old and novel devices and is being used in ongoing randomized trials and registries.

Dual-layer spectral computed tomography aortography using a seventy-five-percent-reduced iodine dose protocol and multiparameter spectral imaging: comparison with conventional computed tomography imaging.

Background: Computed tomography angiography (CTA) is the recommended diagnostic and follow-up imaging modality for acute aortic dissection (AD). However, the high-contrast medium burden associated with repeated CT aortography follow-ups remains a significant concern. This prospective study aimed to assess whether an ultra-low contrast dose (75% cutoff) aortic CTA protocol on dual-layer spectral CT could achieve comparable image quality with the full dose protocol. We also investigated the image quality of the virtual noncontrast (VNC) images derived from the ultra-low dose protocol. Methods: This study included 37 consecutive patients who were referred to aortic CTA from May 2022 to August 2022. The enrolled patients underwent full-dose contrast CTA and ultra-low dose (reduced to 25% of conventional) contrast CTA on dual-layer spectral CT in 1 day. Virtual monochromatic images (VMIs) were reconstructed with 40 and 70 keV. The VNC images were reconstructed for both protocols. Objective image quality evaluation, recorded as signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs), was compared between the groups using 1-way analysis of variance and post hoc analysis with Bonferroni correction. Subjective image quality was also compared between the groups. Finally, VNC images derived from the low-dose (VNClow) and full-dose (VNCfull) protocols were compared to the true noncontrast (TNC) images. Results: Neither CNR nor SNR was lower for the 40-keV images reconstructed from the ultra-low dose group compared to the conventional images. Both were significantly higher than those of the 70-keV images. Regarding subjective image quality, vessel enhancement was not significantly different between the 40-keV VMI and full-dose images [ascending aorta (AAO): 4.37±0.46 vs. 4.57±0.48, P=0.096; brachiocephalic arteries: 4.34±0.45 vs. 4.51±0.49, P=0.152; abdominal aortic side branch: 4.42±0.48 vs. 4.51±0.49, P=0.480]. The VNClow images were similar to the TNC images but significantly different from the VNCfull images (P<0.001). Conclusions: Ultra-low contrast aortic CTA with a 75%-reduced iodine dose using dual-layer spectral CT and the derived VNC achieved image quality comparable to that of conventional CTA and TNC images.

Trends in computed tomography aortography and acute aortic syndrome in an emergency department within Aotearoa New Zealand.

OBJECTIVE: Acute aortic syndrome (AAS) comprises a triad of life-threatening aortic conditions that are difficult to diagnose because of their non-specific clinical presentations. Contrast-enhanced computed tomography aortography (CTA) has a high sensitivity and specificity for these conditions. However, under- and over-investigation of patients with suspected AAS using CTA carries significant risk. The aim of the present study was to evaluate the diagnostic imaging practices of CTA use for patients presenting to an ED with suspected AAS. METHODS: All atraumatic thoracic CTAs performed on patients aged ≥15 years old with suspected AAS who presented to Auckland City Hospital between 2009 and 2019 were included. Outcomes of interest were the annual ED and population incidences of AAS, and the rate of CTAs performed. RESULTS: A total of 1646 CTAs were included. There were 135 (8.2%) cases of at least one AAS diagnosis and 220 (13.4%) cases where an alternative diagnosis was made. The population-adjusted number of AAS diagnoses remained relatively stable over the study period, with a mean annual AAS incidence of 19.6 (95% confidence interval 9.9-33.7) per 100 000 patients, and 3.2 (95% confidence interval 1.6-5.4) per 100 000 population. The number of ED presentations increased during the study period, along with the population-adjusted rate of CTAs performed, from approximately 150 per 100 000 patients (2009) to 350 per 100 000 patients (2019). CONCLUSIONS: Thoracic CTA use for investigating suspected AAS in our ED has recently increased. However, the annual incidence of AAS did not increase over the same period, but was higher than reported in overseas institutions.

Iatrogenic aortic dissection during right transradial intervention in a patient with aberrant right subclavian artery: A case report.

BACKGROUND: Aberrant right subclavian artery (ARSA) is the most common congenital anomaly of the aortic arch. When patients having such anomalies receive transradial intervention (TRI), aortic dissection (AD) may occur. Herein, we discuss a case of iatrogenic type B AD occurring during right TRI in an ARSA patient, that was later salvaged by percutaneous angioplasty. CASE SUMMARY: A 73-year-old man presented to our hospital with intermittent chest pain. Coronary computed tomography (CT) angiography revealed significant stenosis in the left anterior descending artery. Diagnostic coronary angiography was performed via the right radial artery without difficulty. However, we were unable to advance the guiding catheter past the ostium of the right subclavian artery to the aortic arch for percutaneous coronary intervention, while the guidewire tended to go down the descending aorta. The patient suddenly complained of chest and back pain. Emergent CT aortography revealed type B AD propagating to the left renal artery (RA) with preserved renal perfusion. However, after 2 d, the patient suddenly complained of right lower limb pain where the femoral pulse was suddenly undetectable. Follow-up CT indicated further progression of dissection to the right external iliac artery (EIA) and left RA with limited flow. We performed percutaneous angioplasty of the right EIA and left RA without complications. Follow-up CT aortography at 8 mo showed optimal results. CONCLUSION: A caution is required during right TRI in ARSA to avoid AD. Percutaneous angioplasty can be a treatment option.

Diagnostic dilemma in spontaneous innominate artery pathology: a case report.

We report the case of a 71-year-old female who presented with sudden onset of right cervical pain and ipsilateral arm hypoaesthesia. The diagnostic evaluation revealed a pathology of the origin of the innominate artery (IA). The differential diagnosis was among a spontaneous acute dissection and a ruptured pseudoaneurysm. The dilemma of the proper treatment emerged. Surgical or medical treatment? Open or endovascular approach? The patient was offered an open treatment under cardiopulmonary bypass and sort circulatory arrest. As less than ten cases of isolated IA dissection have been previously reported in the literature, we discuss the differential diagnosis difficulties and the treatment options.

Aortic Rupture in Transcatheter Aortic Valve Replacement.

This case demonstrates a rare but catastrophic complication of transcatheter aortic valve replacement (TAVR). In an era where TAVR is now indicated in low-risk patients, serious complication rates are less frequent. It exemplifies the importance of preparedness for vascular injury, with readiness for vascular covered stenting and potential bail-out strategies.

Multidetector computed tomography study to measure thoracic aorta diameters in Egyptian population.

BACKGROUND: The aorta is the largest and strongest artery in the body that plays an important role in the control of systemic vascular resistance and heart rate. Aortic diseases contribute to the wide spectrum of arterial diseases that may be diagnosed after a long period of subclinical development. Multidetector computed tomographic scanners (≥ 64 detector rows) for aortic imaging remain one of the most preferred imaging techniques for diagnosis and follow-up of aortic conditions in acute as well as chronic presentations. The aim of this study is to establish a normal reference values for aortic diameters among Egyptian population and to find which of the cardiovascular risk factors could be an independent determinant of the aortic diameters. RESULTS: Five hundred and sixteen Egyptian individuals were enrolled in our study, the mean age was 53.5 ± 10.9, and males comprised 61.4% of the study population. Aortic root diameters measured at the annulus, sinus and STJ were 23.09 ± 2.55 mm, 33.75 ± 3.93 mm and 26.13 ± 3.05 mm, respectively. The BSA-indexed diameters were 11.70 ± 1.39, 17.10 ± 2.10 and 13.25 ± 1.65, respectively. The diameter of the tubular part of ascending aorta was 30.97 ± 4.16 mm, and the BSA-indexed diameter was 15.71 ± 2.28. The aortic diameters measured at the level of the pulmonary bifurcation were 24.56 ± 2.95 mm and 23.79 ± 2.96 mm at systolic and diastolic phases, respectively. The BSA-indexed diameters were 12.44 ± 1.52 and 12.05 ± 1.52 at systolic and diastolic phases, respectively. At the diaphragmatic level, the mean diameters were 22.39 ± 2.72 mm and 21.49 ± 2.79 mm at systolic and diastolic phases, respectively. The BSA-indexed diameters were 11.34 ± 1.43 and 10.98 ± 1.48 at systolic and diastolic phases, respectively. Age, gender, BSA, BMI and hypertension were statistically significant independent predictors of ascending and descending aortic diameters. CONCLUSIONS: Our study established a normal reference value for thoracic aortic diameters among Egyptians using contrast enhanced MSCT aortography. Age, Gender, BSA, BMI and hypertension are the major determinants of aortic diameters.

Anatomical Variations of the Aortic Arch: A Computerized Tomography-Based Study.

Introduction Despite adequate preparation and meticulous pre-operative assessment, variations of the vascular anatomy of the aortic arch may lead to clinical dilemmas. In the present era, with the easy availability of imaging facilities, various anatomical variations can be found out prior to an interventional procedure. However, there are many countries including India where such facilities may still be not widely available. The purpose of this study was to assess the prevalence of these anatomical variants in patients undergoing Computerised Tomography (CT) chest with contrast. Methods This observational study involved patients who underwent CT chest with contrast as part of various clinical indications during a three-year period in a tertiary care centre in South India. Variations of the aortic arch and its branching pattern were studied in 4,000 chest CT images of patients referred to the radiology department.  Results A total of 4,000 patients underwent CT chest with contrast during the study period. Twenty-seven variations were observed in these patients. They included aberrant right subclavian artery in seven patients, bovine arch in one patient, bovine origin of left vertebral artery from arch in one patient, bronchial artery of anomalous origin from arch in one patient, double aortic arch in one patient, and right-sided aortic arch in 16 patients.  Conclusion The variant anatomy of the aortic arch has tremendous clinical significance, especially from the surgical standpoint. Anatomical variants can also cause difficulty during catheterization while performing endovascular interventions. Given the prevalence demonstrated in our study, imaging may be indicated prior to any procedure involving vascular access in order to prevent unwanted complications.

Asymptomatic complete distal abdominal aortic occlusion with initial presentation of ruptured intracranial aneurysm.

Aortoilliac occlusive disease is occlusive atherosclerosis disease involving the distal aorta and bifurcation of iliac arteries and it is a subtype of peripheral arterial disease. Total occlusion of the abdominal aorta is a rare occurrence with an incidence of 3% -8.5% among the aortoiliac occlusive disease patients. We present a case of a 53 years old patient with a background history of hypertension and ex intravenous drug abuser with negative retroviral screening status, with no previous complaints who was brought to the Emergency Department with sudden onset of altered sensorium and 1 episode of seizure. Computed tomography angiogram of the brain showed a ruptured anterior communicating artery aneurysm. Diagnostic conventional angiogram of the brain was planned; however, difficulty was encountered during bilateral femoral artery cannulation with the abrupt termination of bilateral common iliac arteries. Computed tomography angiogram of the abdomen showed incidental finding of total occlusion of the abdominal aorta. As a conclusion, total occlusion of abdominal aorta secondary to aortoiliac occlusive disease with an associated intracranial aneurysm is never reported in the literature to date. This case highlights the possibility of association in between these two conditions which may benefit from further research.