Diagnostic ultrasound ( PDFDrive )

442 PART II Abdominal and Pelvic Sonography
FIG. 12.11 Type 2 Endoleak. To-and-fro low in the inferior mesenteric
artery illing a small patent space in the aneurysm sac. See also Videos
12.1 and 12.2.
signs and symptoms that may result from aortic occlusive disease
or even the occlusion itself. In the great majority of patients with
aortic stenosis or occlusion, the disease is caused by atherosclerosis.
However, certain clinical settings suggest other causes.
With embolic disease, a dramatic abrupt onset of symptoms
is the best historical evidence of the nature of the event. he
patient can oten relate exactly what he or she was doing when
the symptoms started, even if the event was weeks in the past
(e.g., “I had just gotten up from cutting roses …”). he rapidity
with which the patient seeks treatment depends on the severity
of the reduction in blood low. Embolus to any artery must
be viewed as a very serious and signal event. he majority of
emboli to the abdominal aorta come from the heart. Having an
arterial embolism of any type is similar to having a pulmonary
embolism; having one puts the patient at risk for having more. If
the origin of the embolus is cardiac, the next one that forms may
go to some less favorable place, such as the cerebral circulation,
resulting in stroke, or to the mesenteric circulation, resulting
in intestinal infarction. he workup of any patient identiied as
having an embolus should be expeditious, and anticoagulation
A
B
C
D
E
FIG. 12.12 Type 3 Endoleak. (A) Axial and (B) coronal computed tomography images show a ruptured abdominal aortic aneurysm. The patient
had emergent endovascular aortic repair (EVAR) using disparate components in an attempt to fashion a workable endograft. (C) Axial gray-scale
and (D) color Doppler images one day post EVAR show a gap (yellow arrow) between the tubular portion of the stent graft and the bifurcated
portion (red arrows). Blood low visible throughout the gap. (E) Longitudinal image shows low into the sac that appears to arise from the graft
and not from an aortic branch artery. See also Videos 12.3 and 12.4.