Anomaly of the Descending Aorta
Multifurcation and Reunion
A 52-year-old man was admitted to the emergency department for an ST-segment–elevation myocardial infarction. He did not have any past medical history. We decided to perform an emergent percutaneous coronary intervention with the use of a right femoral arterial puncture. Initially, we failed to advance a 0.035-inch metal guidewire past the level of the infrarenal aorta. After changing to a 0.035-inch hydrophilic guidewire, we barely could pass the aorta and introduce the coronary catheter. After a successful percutaneous coronary intervention, we performed an aortogram to verify the reason why the metal guidewire could not pass the aorta. The aortogram revealed multiple branching of the infrarenal aorta without any distal flow limitation (Figure A). There was no significant pressure gradient between the thoracic aorta and femoral artery. The distal pulses of both lower extremities were intact. The patient was referred for 3-dimensional reconstruction computed tomography angiography to better understand the aortic anatomy. The 3-dimensional computed tomography angiography showed a multiple branching and fenestration of the infrarenal aorta and a reunion at the level of both common iliac arteries (Figure B, anterior view; Figure C, posterior view). The inferior mesenteric artery originated from this branching portion of the aorta without any flow limitation (Figure B, arrow). A maximum-intensity projection image showed no significant calcification of the multifurcated descending aorta (Figure D). There were no anomalous lesions in the ascending aorta and aortic arch (Figure E). The axial plane images showed multiple septations of the descending aorta (Figure F, arrow) and proximal portion of both common iliac arteries (Figure G, arrows). His ankle-brachial index was 0.85 on the right and 0.78 on the left, respectively.
Such an aortic anomaly can be asymptomatic, but it can be problematic during cardiac intervention using the femoral artery. A comprehensive 3-dimensional reconstruction can help obtain a proper structural understanding of the aortic anomaly.
- © 2015 American Heart Association, Inc.