Acute Aortic Disease.. - Index of

80 Raghupathy and Eagle
Figure 6 (A and B). Contrast-enhanced electrocardiogram-gated computed tomography
in a 74 year-old male presenting with Type B dissection. (A) Three dimensional reformatted
image of the thoracoabdominal aorta shows previous repair of the descending thoracic
aorta, with a Type B dissection seen at the distal anastamosis (arrow). (B) The dissection
flap extends through the abdominal aorta (arrows) to the bifurcation, and into the common
iliac arteries bilaterally and external iliac on the left. Source: Courtesy of Dr. Paul Cronin,
University of Michigan, Ann Arbor.
unstable patient and its rapid accessibility (a complete study and diagnosis can
usually be made in less than 30 minutes). Because of its portability, TEE offers the
distinct advantage of intraoperative use in patients requiring emergency surgery.
Limitations of TEE include difficulty imaging the distal ascending aorta, where an
echocardiographic “blind spot” typically exists, as well as the inability to visualize
the distal abdominal aorta (5,13,32,37,44).
Aortography
Long considered the “gold-standard” in diagnosing acute aortic dissection, the
utilization of invasive aortography has largely been supplanted in favor of more
practical, noninvasive imaging modalities such as CT and echocardiography.
Although of adequate sensitivity to diagnose aortic dissection, angiography requires
arterial puncture, exposes the patient to significant amounts of intravascular
contrast, and has limited ability to diagnose intramural hematoma. Aortography
does offer a few advantages, including the opportunity to measure hemodynamics
between true and false lumen and, when indicated, to perform endovascular