MDCT Figure 1 Stent-grafts for abdominal aortic aneurysm. : Zenith Endovascular Graft (Cook). : Excluder (Gore). C: Powerlink (Endologix). C Figure 2

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るるみふじがわ
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1 Online publication pril 1, 2011 総説第 50 回総会シンポジウム 10 日本 IVR 学会 : 画像診断の進歩と血管内治療への応用腹部および胸部大動脈瘤に対するステントグラフト治療 MDCT による術前術後評価要旨 : MDCT MDCT J Jpn Coll ngiol, 2011, 51: Key words: EVR, TEVR, MDCT, computed tomography はじめに 3 2 multidetector CT MDCT MDCT endoleak MDCT 腹部大動脈瘤のステントグラフト治療 1 Zenith Endovascular Graft Cook Excluder Gore Powerlink Endologix 3 Fig. 1 Zenith Excluder 18 F Powerlink Zenith Excluder 1 2 Powerlink 15 mm mm mm 1 2 MDCT 3 mm CT 2 MDCT mm mm Thin slice volume rendering 3DCT curved planar reconstruction CPR Fig F 6.8 mm 20 F THE JOURNL of JPNESE COLLEGE of NGIOLOGY Vol. 51 No

C Figure 2 Measurement of abdominal aortic aneurysm using software on a volume-rendered three-dimensional (3D) MDCT image

2 MDCT Figure 1 Stent-grafts for abdominal aortic aneurysm. : Zenith Endovascular Graft (Cook). : Excluder (Gore). C: Powerlink (Endologix). C Figure 2 Measurement of abdominal aortic aneurysm using software on a volume-rendered three-dimensional (3D) MDCT image () and curved planar reconstructed images (). The diameters of the proximal and the distal landing zone (neck) and the length of the artery at the centerline are calculated. 7.5 mm Fig. 3 Fig. 4 3 MDCT CT 106 脈管学 Vol. 51 No. 1

: Dilatation of the right common iliac artery associated with massive thrombus (arrow) and the left hypogastric artery aneurysm (arrowheads). : Short left common iliac artery (arrow).

3 4 Figure 3 3DCT images of abdominal aortic aneurysms with the iliac arteries unsuitable for regular stent-grafting. In these cases, the hypogastric arteries were embolized with coils, and the stent-graft was placed at the external iliac arteries. : Dilatation of the right common iliac artery associated with massive thrombus (arrow) and the left hypogastric artery aneurysm (arrowheads). : Short left common iliac artery (arrow). Figure 4 bdominal aortic aneurysm with dilated iliac arteries. : 3DCT before treatment shows bilaterally dilated and short common iliac arteries. : The right and the left hypogastric arteries were embolized as separated procedures, and both legs of the Zenith stent-graft were placed at the external iliac arteries. March 25,

6 TG Excluder Talent TG Talent Figure 5 Classification of endoleaks (from Guidelines for Diagnosis and Treatment of ortic neurysm and ortic Dissection, JCS

4 MDCT endoleak 3 Endoleak type I V Fig. 5 3 MDCT type I IV 2 endoleak 10 type II Type II Type I type III endoleak 1 MDCT 胸部大動脈瘤のステントグラフト治療 1 TG Gore Talent Medtronic 2 Fig. 6 TG Excluder Talent TG Talent Figure 5 Classification of endoleaks (from Guidelines for Diagnosis and Treatment of ortic neurysm and ortic Dissection, JCS 2006). Type I: Perigraft leak. Type II: Side branch endoleak. Type III: Connection leak / fabric leak. Type IV: Porosity leak. Type V: Endotension: neurysm sac enlargement without sac enhancement on CT. Figure 6 Stent-grafts for thoracic aortic aneurysm. : TG (Gore) : Talent (Medtronic) 108 脈管学 Vol. 51 No. 1

4 Figure 7 Thoracic aortic aneurysm treated with stent-grafting. : 3DCT image before treatment demonstrates a large descending aortic aneurysm.

5 4 Figure 7 Thoracic aortic aneurysm treated with stent-grafting. : 3DCT image before treatment demonstrates a large descending aortic aneurysm. : 3DCT image after treatment using three pieces of TG stent graft shows a successful result without endoleak. 2 cm debranching mm 1 2 MDCT 3DCT CPR 1 10 cm 20 cm 2 cm3 cm 5 cm 3 Fig. 7 3 MDCT MDCT endoleak Fig. 8 debranching MDCT type II endoleak endoleak おわりに MDCT 3D MDCT March 25,

MDCT Figure 8 Imaging and management of endoleak after stent-grafting for thoracic aortic aneurysm. : 3DCT image before treatment shows an aneurysm at the distal aortic arch.

Type-2 endoleak via the left subclavian artery was suspected. C: Left subclavian arteriography confirmed the type-2 endoleak (arrows).

6 MDCT Figure 8 Imaging and management of endoleak after stent-grafting for thoracic aortic aneurysm. : 3DCT image before treatment shows an aneurysm at the distal aortic arch. : 3DCT image after debranching with right carotid to left carotid and left subclavian artery bypass (arrows) and Talent stent graft placement shows partial enhancement of the aneurysm sac. Type-2 endoleak via the left subclavian artery was suspected. C: Left subclavian arteriography confirmed the type-2 endoleak (arrows). D: The orifice of the left subclavian artery was embolized with coils. E: 3DCT image after coil embolization shows no endoleak. E C D 文献 1 IVR pro/aaa/ Circ J, 2006, 70 Suppl IV. 110 脈管学 Vol. 51 No. 1

7 4 Endovascular Repair of bdominal and Thoracic ortic neurysms: Preoperative and Postoperative Evaluation with Multidetector CT Tsueno Ishiguchi, 1 Seiji Kamei, 1 Toyohiro Ota, 1 Hiroyuki Ishibashi, 2 and Takashi Ohta 2 1Department of Radiology, ichi Medical University 2 Department of Vascular Surgery, ichi Medical University Key words: EVR, TEVR, MDCT, computed tomography The number of patients treated by stent-grafting for abdominal and thoracic aortic aneurysm is increasing. For abdominal aortic aneurysms, three types of stent grafts are currently commercially available in Japan. Preoperative hypogastric artery embolization using coils is performed in patients with short or dilated common iliac artery. For thoracic aortic aneurysms, two types of stent grafts are available. In cases with short-neck distal arch aneurysms, preoperative bypass graft to the left common carotid artery and the left subclavian artery (debranching) is useful to secure the proximal landing zone. Multidetector CT (MDCT) plays important roles in preoperative and postoperative evaluations. In addition to the thin-slice axial CT images, volume-rendered three-dimensional reconstruction, maximum intensity projection, multiplanar reconstruction, and curved planar reconstruction images are provided by the workstations and used for measurement and device selection. Endoleaks after stent-grafting are classified into five types. MDCT is useful for the assessment of the type and the cause of endoleaks leading to secondary interventional repair. MDCT images of the representative cases of abdominal and thoracic aortic aneurysms are presented. (J Jpn Coll ngiol, 2011, 51: ) March 25, 2011 Online publication pril 1,

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