Complex aortic disease: Changes in perception, evaluation and management

This three-dimensional reconstruction of a computed tomography scan of a fenestrated endograft in situs shows the incorporation of renal and superior mesenteric arteries. The uncovered stent is apposing the celiac orifice. Postprocessing software provides the ability to interrogate the repair to assess stent integrity and aneurysm sac changes.

The strategy of approach for complex cases, such as endograft failures, are facilitated using postprocessing imaging, which provides the needed detail and relational anatomy to size and plan a repair in the presence of a previous device. A, A failed aortic endograft is depicted, and the short-bodied graft design and crossed limbs will have ramifications for repair. B, A different patient who has had an endo-to-endo conversion of an original aortic repair is shown.

A computed tomography scan during a patient's workup for aortic repair is shown with analytic surfaces generated using our geometric analyses. Left, The intensity-cropped arterial scan. Middle, The analytic surface is superimposed in a wire frame. Right, The same surface is shown rendered with a shading model to show the complexity of the geometry. (Permission to reproduce granted by IEEE Computer Graphics and Applications. Goel VR, Greenberg DP, Greenberg RK. Automated Vascular Geometric Analysis of Aortic Aneurysms, Figure 10c).