Diagnosis and Treatment of Aortic Aneurysm and Dissection

This article discusses the radiographic imaging of aortic aneurysms and aortic dissection. The most common modalities include Ultrasound, CT, and Interventional Radiology. The article also includes pre and post endograph stent imaging.

Author: Joseph, Phelan, Edmundson
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Please note: This unit contains numerous images and may download slowly. If all of the images don't load, click the re-load button on your browser to continue loading the remaining images. Depending on your connection speed, you may need to click the reload button more than once. Aortic Aneurysm and Dissection Written by Nicholas Joseph Jr. RT(R)(CT) B.S. M.S

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Objectives

Introduction

Anatomy of the Aorta

Pathophysiology of AAA

Summary Points

References

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Introduction

Aortic aneurysm is defined as a local dilatation of the aorta that exceeds its normal diameter by greater than fifty-percent. Aneurysm of the aorta can occur anywhere along its length including the thoracic, abdomen, or at its bifurcation into the common iliac arteries. Aortic aneurysms occur most commonly in the abdomen and are called abdominal aortic aneurysm (AAA). About 90% of abdominal aneurysms occur below the renal arteries (infrarenal). Abdominal aortic aneurysm occurs most commonly in Caucasian males between the age of 65 and 75 years, and is especially higher in smokers. Most aneurysms are asymptomatic, therefore, are discovered on radiographs taken for other reasons. Nonetheless, aortic aneurysm is the 15th leading cause of death in the United States. Symptoms of an aneurysm include noncardiac chest pain, flank pain, abdominal pain, back pain, groin pain, or a pulsating abdominal mass. The infrarenal aorta is about 2cm in diameter, so a dilatation greater than 3 cm is considered to be an aneurysm. However, an aneurysm that is less than 5 cm is watched closely with routine computed tomography (CT). Treatment does not usually occur until the dilatation is greater than 5 cm or becomes symptomatic. The greatest complication of aneurysm is the risk of rupture. The mortality of AAA rupture is about 90% so large or symptomatic AAA’s are treated. The operative mortality is also high (reported to be nearly 40%). Because clinical symptoms are often vague, imaging for aortic aneurysm and dissection is a fairly common study in radiology. This article investigates radiographic imaging of the aorta for AAA including pre and post endograph studies, 3D CT aorta imaging, maximum intensity projection (MIP), aorta ultrasound, and interventional angiography.

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