PMC4797187_01
Contrast-enhanced CT imaging. a) Contrast-enhanced CT at the level of the lower abdominal aorta. A nonenhancing mass is recognized in the aortocaval space. The IVC is compressed and narrowed. b) Contrast-enhanced CT at the level of the terminal aorta. A large aneurysm with an irregular shape is recognized. c) Contrast-enhanced CT at the level of the CIA. The aneurysm and normal left CIA are visualized. Early venous filling of the left CIV and filling defect of the right CIV are recognized. d) Coronal multiplanar reconstruction contrast-enhanced CT image. An aneurysm arising at the terminal aorta and compressed IVC are recognized.
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Fig1
CT showed an aneurysm at the level of the terminal aorta, IVC compression, and early venous filling into the iliac veins (Figure 1a-1d). CT angiography (CTA) revealed AAA and right CIA aneurysm (Figure 2).
Preoperative 3D volume rendering image in the anterior view. A large aneurysm from the lower part of the abdominal aorta to the right CIA is observed. There is stenosis of the IVC due to displacement of AAA. The fistulous venous return to the IVC runs via the peripheral dilated veins in the bilateral internal iliac veins, dilated left and right ovarian veins, and left renal vein.
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Fig2
CT showed an aneurysm at the level of the terminal aorta, IVC compression, and early venous filling into the iliac veins (Figure 1a-1d). CT angiography (CTA) revealed AAA and right CIA aneurysm (Figure 2).
Angiographic imaging. a) The initial abdominal aortic angiogram. A large aneurysm arising from the lower abdominal aorta to the right CIA is observed. There is also early venous filling in the right CIV. b) An angiogram after stent graft placement. The aneurysm is excluded. No endoleaks are observed. Early venous filling of the right CIV has disappeared.
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Fig3
Early venous filling of the internal iliac veins and ovarian veins was also visualized (Figure 3a). Aortic angiography showed no endoleaks after stent graft insertion (Figure 3b).
Venographic imaging. a) Venography from the right femoral vein immediately after stent graft insertion. The contrast agent has filled the excluded aneurysmal sac. The IVC is visualized but compression is still present. b) Venography from the right femoral vein immediately after stent graft insertion. The left CIV is visualized; however, it is occluded. c) Bilateral femoral vein angiogram after kissing technique stent insertion. Severe stenosis in the IVC has improved, and caval venous flow has recovered after insertion of bare metallic stents. Minimal contrast agent filling of the aneurysmal sac is observed.
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Fig4
Right femoral vein angiography confirmed the entry of contrast agent into the aortic aneurysm and narrowing of the IVC (Figure 4a). Left femoral vein angiography showed obliteration of the left CIV (Figure 4b). AZ, USA) were then inserted at the same site from the right and left femoral veins, respectively, using the kissing method. After insertion of the bare metallic stents, venography of the bilateral femoral veins showed good flow from the femoral vein to the IVC (Figure 4c).
Postoperative 3D CTA, anterior view. There is no endoleak in the stent graft. The fistulous flow has also disappeared. The left external iliac artery to the right common femoral artery (I-F) bypass flow shows good patency.
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Fig5
Iliofemoral bypass showed normal flow into the bilateral femoral arteries (Figure 5).