Ann Thorac Surg 2003;76:947
© 2003 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Assessment of stent-grafting for aortic dissection using multislice computed tomography
Yoshihiko Kurimoto, MDa*,
Naoya Yama, MDb,
Kiyofumi Morishita, MDc,
Yasufumi Asai, MDa,
Tomio Abe, MDc
a Department of Traumatology and Critical Care Medicine, Sapporo, Japan
b Department of Radiology, Sapporo, Japan
c Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan
* Address reprint requests to Dr Kurimoto, Department of Traumatology and Critical Care Medicine, Sapporo Medical University, South 1 West 16, Chuo-ku, Sapporo 060-8543, Japan
e-mail: kurimoto{at}sapmed.ac.jp
A 49-year-old woman was admitted to our department for treatment of chronic type B aortic dissection. Multislice computed tomography (MCT) revealed the maximum diameter of the descending aorta to be 7 cm. Aortography revealed that the entry and reentry sites were 4-cm distal to the left subclavian artery (Fig 1)
and near the celiac artery, respectively. The patient, due to her religion (Jehovah’s witnesses), insisted that blood transfusion not be performed even in a critical situation. Therefore, we concluded that standard surgery could not be performed but that endovascular stent-grafting to close the entry site might reduce the risk of possible aortic rupture. The stent-graft was handmade to fit the tortuous true lumen of the proximal descending aorta using 40-mm Gianturco Z-stents (Cook Inc, Bloomington, IN) covered with a 30-mm UBE vascular graft (Ube Corp, Ube, Japan) of 12-cm length. The stent-graft was delivered to close the entry site and thrombo-occlude the false lumen of the descending thoracic aorta. The amount of blood loss was 100 mL. The patient was discharged 1-week after the stent-grafting. Multislice computed tomography angiography (posterior view, Fig 2)
clearly demonstrated a change in the blood flow in the descending aorta before the operation (left side) and after the operation (right side). White arrowheads and black arrowheads indicate the patent false lumen and the narrowed true lumen, respectively (left side). White arrows indicate the thrombosed false lumen diameter was much reduced (right side).
Multislice computed tomography scanners can provide image quality two to three times better than single-slice CT, and the resolution of MCT angiography is comparable with conventional angiography. Because of postoperative assessment of stent-grafting, MCT can provide images of high quality revealing the correct relationship among blood flow in the true and false lumens, mural thrombus, and metal of the stent-graft.
