[Clinical value of dual-source CT angiography in the diagnosis of postoperative aortic intramural hematoma in patients with endovascular stent-graft exclusion surgery].

ABSTRACT

OBJECTIVE: To determine the clinical value of dual-source CT angiography (DSCTA) in the diagnosis of postoperative aortic intramural hematoma (AIMH) in patients with endovascular stent-graft exclusion (EVE) surgery. METHODS: Between Oct 2008 and May 2013, thirty-six patients were diagnosed with AIMH by DSCTA, and 12 of these patients with type B underwent EVE. The 12 patients were followed up with DSCTA, which included imaging reconstruction (multi-plane reconstruction, MPR), maximum intensity projection (MIP) and volume rendering technique (VRT). The extent and type of AIMH, aortic ulcers and the outcomes and complications of AIMH were observed. RESULTS: The 36 cases of AIMH included 11 Stanford type A and 25 type B. No tearing intimal flap or contrast materials within the hematoma were observed. The maximum aortic diameter of the hematoma areas varied from 3.8 to 5.4 cm (average 4.3 cm) and the maximum thickness of the hematoma ranged from 0.5 cm to 1.3 cm (average 0.9 cm). The ratio between the minimum and the maximum diameter of the aortic lumen in the hematoma areas ranged from 0. 74 to 0. 98 (average 0.85). Aortic ulcers were revealed in 3 patients with type A AIMH and 8 patients with type B AIMH. Intimal tearing of distal abdominal aorta was found in 3 patients with type B AIMH. In the 12 patients underwent EVE surgery, hematoma shrank in all cases with 4 cases almost resolving and aortic ulcers in the area of stent-graft exclusion disappeared in 3 cases. The form of stent-graft appeared normal in 9 cases and slightly abnormal in 3 cases. Fluent main branches of aortic arch and none existence of stent endoleaking were observed. CONCLUSION: DSCTA with handy, effective and non-invasive advantages is one of the important imaging methods in the diagnosis of AIMH in patients with EVE surgery.