SELECTIVE AORTOGRAPHY, THE DEFINITIVE TECHNIQUE, FOR DIAGNOSIS OF DISSECTING ANEURYSM OF THE AORTA

Abstract

Percutaneous catheter aortography was used in 18 patients safely and without complications. Transfemoral or transaxillaxy arterial puncture, or both, were used, depending upon the presence and quality of peripheral pulses, and need to secure complete evaluation of both the thoracic and abdominal aorta. The definitive diagnosis of dissecting aneurysm requires opacification of a double-lumen aorta with visualization of the lucent wall between the 2 channels. Complete and incomplete opacification of the false channel was encountered, depending upon patency of the false channel. The various patterns of incomplete thrombosis of the false channel in the thorax, such as ulcer-like projections into the false channel and localized extravasation of contrast material at sites of intimal tear are described and illustrated. When complete thrombosis of the false thoracic lumen is found, visualization of 2 distinct channels in the abdominal aorta confirms the diagnosis. Evaluation of the full extent of the dissection is incomplete without the examination of the abdominal aorta in 1 or more projections. Suggestive signs of aortic dissection are narrowing of the opacified channel and incomplete filling of arteries to clinically viable viscera.