Rotational Aortogram With Three-Dimensional Reconstruction in a Case of Celiac Artery Stenosis
A 65-year-old woman with a history of hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, and peripheral vascular disease presented to the hospital after 4 months of severe postprandial diffuse abdominal pain 15 minutes after eating and accompanied by emesis. Before admission, she had undergone a complete gastrointestinal evaluation, including liver and pancreatic function tests, an abdominal ultrasound that showed no signs of hepatobiliary disease, and an upper endoscopy that showed mild erosive gastritis with a positive test for Helicobacter pylori.
Because her symptoms suggested abdominal angina, magnetic resonance angiography was performed. This study suggested celiac artery stenosis. She then underwent abdominal rotational aortography with 3D reconstruction, which showed a significant celiac artery stenosis (Figure). After the rotational aortography, the patient underwent successful celiac artery percutaneous angioplasty and stent implantation. Immediately after catheterization her pain resolved and she began her dietary intake. Two days latter she was consuming a normal diabetic diet and starting a physical rehabilitation program with no limitations.
Rotational aortography with 3D reconstruction is an angiographic technique currently under clinical development. It consists of a 180-degree fast rotation (22.5 degrees/second) of the C-arm around the plane of imaging, while a bolus of contrast is injected through a power injector with a pigtail catheter in the area of interest. This motion creates a real-time 3D picture of the structures studied. The images are processed by specialized software to create a 3D tomographic model, which can be rotated around in its 3 axes to establish an optimal viewing plane. This model is immediately available to the angiographer using a single contrast injection to make diagnostic or therapeutic decisions and allows the evaluation of complex vascular structures that will otherwise require different views with orthogonal angles.
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.