Endovascular Procedures

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Ectopic Gas: A Sign for Potential Aortic Endoprosthesis Infection before Symptoms

Introduction

Abdominal aortic endoprosthesis (AAE) infection is the most dreaded complication of endovascular aortic repair (EVAR) for abdominal aortic aneurysm (AAA), with mortality rates reported as high as 51.8%. Recent meta-analyses emphasize that despite advances in surgical technique, the prognosis of AAE infection remains poor due to delayed diagnosis and the complexity of endoprosthesis explantation.^, The management of AAE infection is significantly hindered by diagnostic latency. Currently, computed tomography angiography (CTA) is typically reserved for evaluation only after the onset of infectious symptoms. Although periprosthetic exudation and ectopic gas are considered hallmark radiographic features, these signs are often subtle and minute during the early, pre-symptomatic stages of infection, rendering them easily overlooked. We present a case in which a radiologist detected minute periprosthetic ectopic gas via thin-section CT during a routine CTA follow-up, five days before the onset of infectious symptoms, thereby alerting clinicians to the possibility of AAE infection. Based on this case, we underscore the critical value of thin-section CT in the early identification of ectopic gas. Furthermore, we aim to demonstrate how advanced post-processing—specifically volume rendering (VR) and hyper-realistic rendering (HRR)—enhances the visualization of AAE infection, thereby enabling longitudinal monitoring of infection progression.

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Editorial

Unfolding Type B Aortic Dissection Controversies – Piecing Together the Evidence

Walter J. Gomes et al. Eduardo N. Gomes Nelson A. Hossne Jr.

Unlike type A aortic dissection, many aspects of the natural history of type B aortic dissection (TBAD) remain blurred and unsettled, leading to uncertainties in its prognosis, recommendations, and management.^, Among the critical factors impacting TBAD outcomes, the thrombosis of the false lumen seems to be an associated finding exhibiting a robust correlation with late prognosis and conveying significant clinical implications. In addition to being a critical prognostic indicator for TBAD patients, the presence or absence of false lumen thrombosis has been employed to guide treatment decisions, affecting the choice of therapeutic interventions, the thoracic endovascular aortic repair (TEVAR) and adjusting post-treatment follow-up.

In this way, Tang et al. report an interesting aspect of the correlation between imaging and clinics in this issue. Analyzing a large cohort of consecutive patients with TBAD, they investigated the factors affecting false lumen thrombosis in patients with TBAD, focusing on understanding the role of aortic morphology in the thrombosis of the false lumen. Computed tomographic angiography images were used for measurements. Specialized software reconstructed three-dimensional models of aortic dissection, and measurements of true and false lumen diameters were performed at different zones of the aorta. The incidence of thrombotic false lumen was higher in older patients with normal renal function than in younger patients or those with compromised kidney function.

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Ectopic Gas: A Sign for Potential Aortic Endoprosthesis Infection before Symptoms

Introduction

Unfolding Type B Aortic Dissection Controversies – Piecing Together the Evidence

Electronic Document Format (Vancouver)

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Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)