PMC101372_01
Direct roentgenogram of the abdomen shows smooth contoured density increase on left side of vertebral column.
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F1
Direct roentgenograms revealed a smooth contoured density increase on left side of vertebral column (Figure 1).
A, B. Abdominal helical CT images show prominent destruction in the left anterolateral portion of the lumbar vertebra corpus and 10 x 10 x 15 cm saccular aneurysm originating from a 3.5 x 1 cm defect in the left posterolateral aspect of the abdominal aorta and thrombus inside. The vertebral destruction was probably due to pulsation of the aneurysm.
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F2
Then dynamic abdominal CT was performed which showed an infrarenal, 10 x 10 x 10 cm saccular aneurysm originating form a 3.5 x 1 cm defect on the left posterolateral aspect of abdominal aorta, with thrombus inside (Figure 2A, 2B).
A, B, C, D, E. Sagittal reformat CT image (A), surface shaded display (SSD) 3D images (B, C) and maximum intensity projection (MIP) multiplanar volume reformat (MPVR) images (D, E) show neck of the aneurysm, anterior displacement of the aorta and patency of the iliac bifurcation and iliac arteries.
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F3
CT angiography (CTA) and 3D reconstructions were made (Figure 3A, 3B, 3C, 3D, 3E). CT examinations were performed with GE ProSpeed Helical scanner and for the reformat images and 3D reconstructions Advantage Windows version 2.0 Voxtool software on a separate workstation was used.
A, B. C-arm fluoroscopy image obtained during the procedure in the operating room show the patency of renal arteries (A) and deployed stent graft (B). Arrowhead points to the contrast material entrapped inside the aneurysm sac.
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F4
Intraprocedural control conventional angiography showed the patency of renal arteries and proper position of the deployed stent graft and entrapped contrast material inside the aneurysm sac (Figure 4A, 4B).
A, B, C, D, E. Abdominal helical CT (A), sagittal reformat CT (B) and SSD images (C) show non-filling of the aneurysm sac and complete sealing of the defect. Abdominal CT images shows right (D) and left (E) patent renal arteries.
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F5
Control abdominal CT examination and 3D reconstructions revealed complete sealing of the aneurysm sac by the stent graft, patency of the renal arteries and visceral arteries and no endoleak was noted (Figure 5A, 5B, 5C, 5D, 5E).
A, B. Control abdominal CT image after 18 months shows a decrease in the size of the aneurysm sac and patency of the stent graft. No endoleak was noted.
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F6
After 18 months there were no complications (Figure 6A, 6B).