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Descending Thoracic Aortic Aneurysm: Thoracic CT Findings after Endovascular Stent-Graft Placement¹

¹ From the Department of Cardiovascular and Interventional Radiology, Stanford University Medical Center, 300 Pasteur Dr, Suite H3630, Stanford, CA 94305-1056 (T.S., M.D.D., C.P.S., T.Y., A.A., S.T.K., M.K.R., D.Y.S.), and the Department of Radiology, Fukui Medical University School of Medicine, Fukui, Japan (N.H.). Received April 1, 1998; revision requested June 25; revision received September 14; accepted December 16. Address reprint requests to M.D.D. (e-mail: mddake@stanford.edu).

PURPOSE: To evaluate the usefulness of thoracic computed tomography (CT) after placement of an endovascular stent-graft for the treatment of descending thoracic aortic aneurysm.

MATERIALS AND METHODS: From 1992 to 1996, 85 patients with thoracic aortic aneurysm underwent stent-graft placement. In 63 patients, thoracic CT scans were obtained both before and within 10 days after placement. The CT findings were retrospectively studied, and their clinical effect analyzed. In 20 of 63 patients, long-term follow-up CT findings were also evaluated.

RESULTS: After stent-graft placement in the 63 patients, CT demonstrated an increase in pleural effusion in 46 (73%), periaortic changes in 21 (33%), perigraft leak in 13 (21%), atelectasis in six (10%), mural thrombus within the stent-graft in two (3%), and new aortic dissection in one (2%). The mean maximum diameter of the aneurysm was 58.8 mm before and 60.0 mm after stent-graft insertion. Sixty-two (98%) patients were successfully treated until discharge. Interventional procedures were performed to eliminate the leakage into the aneurysm sac in 10 patients with perigraft flow depicted at CT. Other complications were managed conservatively.

CONCLUSION: Thoracic CT is useful in the treatment of patients after stent-graft insertion for the management of descending thoracic aortic aneurysm.

Index terms: Aneurysm, aortic, 563.732, 943.73 • Aorta, grafts and prostheses, 563.1269, 943.1268 • Aorta, interventional procedures, 563.1269, 943.1268

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