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(Circulation. 2001;104:e154.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Three-Dimensional Images of Extra-Anatomic Arterial Bypass Graft Using Multidetector Row Spiral Computed Tomography Data With Volume Rendering

Jürgen K. Willmann, MD; Michael Szente-Varga, MD; Justus E. Roos, MD; Paul R. Hilfiker, MD; Dominik Weishaupt, MD

From the Institute of Diagnostic Radiology (J.K.W., J.E.R., P.R.H., D.W.) and the Clinic of Cardiovascular Surgery (M.S.-V.), University Hospital Zurich, Zurich, Switzerland.

Correspondence to Dominik Weishaupt, MD, Institute of Diagnostic Radiology, University Hospital, Raemistrasse 100, 8091 Zurich, Switzerland. E-mail dominik.weishaupt{at}dmr.usz.ch

A 71-year-old patient was referred to our department for postoperative evaluation of an extra-anatomic aortobi-femoral bypass graft (Dacron) from the distal thoracic aorta to both common femoral arteries. Eight days earlier, the patient had undergone surgical resection of an anastomotic aneurysm, with interposition of a short new graft segment at the right distal anastomosis of the bypass graft. The extra-anatomic aortobifemoral bypass had been implanted 9 years previously due to a severe infection of an infrarenal aortic bifurcation prosthesis. At that time, the infected prosthesis was removed, with subsequent ligation of the infrarenal abdominal aorta.

Multidetector row spiral computed tomography (MDCT) angiography (Somatom Volume Zoom, Siemens AG) was performed after the administration of 120 mL of iodixanol (Visipaque 300, Nycomed Amersham Imaging AS) at a flow rate of 3 mL/s using a power injector. The entire anatomic area from the supraaortic vessels down to the femoral arteries was scanned within 1 breathhold by using a collimation of 2.5 mm and a table feed of 25 mm/s. Images were reconstructed with a slice width of 3 mm and a reconstruction interval of 2 mm. Three-dimensional volume-rendering images of the MDCT data sets were performed (Figures 1 and 2 and Online Figure I).

View larger version (81K): [in this window] [in a new window]   Figure 1. Color-enhanced, 3D volume-rendering images using multidetector row spiral CT data set. A, Anterior view; B, Posterolateral view. The aortobifemoral bypass graft from the thoracic aorta (black arrowhead) to the right and left common femoral artery (thin white arrows) can be demonstrated. The distal graft anastomosis can be appreciated in good anatomic detail, despite the presence of surgical clips. In addition, an interposed short new graft segment is also visible (thick white arrows). Note retrograde filling of contrast material into the left internal and left external iliac artery (white arrowheads) and complete ligation of infrarenal abdominal aorta.

View larger version (51K): [in this window] [in a new window]   Figure 2. Targeted, color-enhanced, 3D volume-rendering reconstruction of the distal arterial bypass graft confirms the normal appearance of the distal anastomoses (thin white arrows). Note postoperative clip material (white arrowheads) and additional interposed short new graft segment (thick white arrow).

MDCT angiography allowed evaluation of the entire extra-anatomic aortobifemoral bypass graft. Proximal and distal graft anastomosis could be evaluated in detail. The presence of vascular clips used for vessel ligation did not alter image quality.

Retrograde filling of contrast material into the left internal and right external artery was visible. Otherwise, no abnormal finding of the extra-anatomic bypass graft was detected on MDCT angiography. The patient was discharged on the eighth postoperative day.

Footnotes

Figure I is available as an Online Only Data Supplement at http://www.circulationaha.org

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

(Circulation. 2001;104:e154-e155.)

This Article Extract Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Willmann, J. K. Articles by Weishaupt, D. Search for Related Content PubMed PubMed Citation Articles by Willmann, J. K. Articles by Weishaupt, D. Related Collections Imaging Peripheral vascular disease CT and MRI CV surgery: aortic and vascular disease