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The Dissected Aorta Part III. Anatomy and Radiologic Diagnosis of Branch-Vessel Compromise

 David M. Williams  ;  Do Yun Lee  ;  Brian H. Hamilton  ;  M. Victoria Marx  ;  Dasika L. Narasimharn  ;  Sahira N. Kazanjian  ;  Martin R. Prince  ;  James C. Andrews  ;  Kyung J. Cho  ;  G. Michael Deeb 
 RADIOLOGY, Vol.203(1) : 37-44, 1997 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting/complications ; Aneurysm, Dissecting/diagnostic imaging* ; Aneurysm, Dissecting/physiopathology ; Aortic Aneurysm/complications ; Aortic Aneurysm/diagnostic imaging* ; Aortic Aneurysm/physiopathology ; Aortography ; Humans ; Ischemia/etiology ; Manometry ; Middle Aged ; Ultrasonography, Interventional
PURPOSE: To determine the anatomic, hemodynamic, and radiologic characteristics of branch-vessel compromise in patients with aortic dissection. MATERIALS AND METHODS: Sixty-two patients with aortic dissection were evaluated with aortography (n = 62), intravascular ultrasound (US) (n = 35), and manometry (n = 56). Branch-vessel compromise with ischemia was suspected in 40 of these patients. Radiologic and manometric findings were correlated with clinical findings of ischemia. Femoral artery pulse strength was correlated with access from the respective femoral artery to the true and false lumina of the dissected aorta. RESULTS: Twenty-six of 40 patients suspected of having ischemia had angiographic evidence of branch-vessel compromise, and intravascular US helped identify two types of branch-vessel compromise in them: static (dissection intersected and narrowed the vessel origin) and dynamic (dissection spared the vessel origin, but the dissection flap appeared to compress the true lumen at or above the origin and covered the origin). False-lumen pressure in classic dissections exceeded (n = 16) or equaled (n = 30) true-lumen pressure. Branch vessels that arose exclusively from the false lumen were well perfused. Findings of a dissection flap oriented concave toward the false lumen were 91% sensitive and 72% specific for a true-lumen pressure deficit. CONCLUSION: Intravascular US and manometric findings clarify the mechanisms of branch-vessel compromise after aortic dissection and provide a rational guide for percutaneous treatment.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Lee, Do Yun(이도연)
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