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73
What is nontarget
embolization?
Migration of the embolic device
or material from the intended
target artery into an undesired
artery due to reflux or unintended
catheter movement.
When performing bronchial
artery embolization, what
are the critical vessels to be
aware of?
Any arterial supply to the spinal
cord, specifically the anterior
spinal artery, since nontarget
embolization of the anterior spinal
artery can cause paraplegia.
What are the most important
properties of embolization
coils?
Target vessel diameter
Configuration (tertiary
configuration, loop diameter, and
length)
Stiffness
Volume (packing density)
Define coil packing density. Packing density is defined as the
number of coils multiplied by
coil volume divided by aneurysm
volume. High packing density
and low residual aneurysm
volume decrease the likelihood of
aneurysm recanalization.
Further Reading
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M. C. Taon
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Part III
Vascular Disease
https://t.me/med1917
81© Springer Nature Switzerland AG 2022
R. Chand et al. (eds.), Essential Interventional Radiology
Review, https://doi.org/10.1007/978-3-030-84172-0_17
Evaluating Patient
What are the
findings of AAA
on physical exam?
Midline palpable pulsatile abdominal mass
What is the
diameter that is
used to define an
AAA?
> 3cm or 1.5x the normal diameter
Who should be
screened for
AAA?
The USPSTF recommends onetime
ultrasound screening of men between the
ages of 65 and 75 with a smoking history.
The USPSTF also recommends selective
onetime ultrasound screening of men aged
65–75 based on patient’s medical history,
family history, and risk factors.
The USPSTF states that data is insufficient
to recommend AAA screening for women
with and without smoking history.
Chapter 17
Abdominal Aortic
Aneurysms
DaniaDaye
D. Daye (*)
Department of Radiology, Massachusetts General Hospital,
Harvard Medical School, Boston, MA, USA
e-mail: ddaye@mgh.harvard.edu
(continued)
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82
What study is
used to screen a
patient for AAA
and follow the
aneurysm size over
time?
Ultrasound
What study should
be ordered if an
AAA leak or
impending rupture
is suspected?
CT with contrast in usually recommended.
However, a non-contrast CT can be
sufficient if there is concern for contrast-
induced nephropathy.
Abdominal CT allows differentiating
ruptured from non-ruptured aneurysms,
allows the identification of the extent of the
aneurysms, and provides important anatomic
information to determine suitability for
endovascular repair.
What are the signs
of abdominal
aortic rupture on
CT?
Retroperitoneal hematoma or stranding.
Indistinct aortic wall or loss of fat plane
between aortic wall and surrounding tissues.
The “draped aorta” sign is an inseparable
tissue plane between a concave posterior
aorta and the adjacent lumbar vertebral
body. It is associated with impending
or contained rupture. Retroperitoneal
fibrosis may also cause loss of tissue
plane distinction but often pulls in the
ureters medially (aneurysm will push
them out) and contributes to upstream
hydroureteronephrosis, as well as often
narrows the aorta and IVC.
Contrast extravasation.
What is the
presentation triad
of a patient with a
leaking AAA?
Abdominal pain, hypotension, and pulsatile
abdominal mass
D. Daye
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83
What medical
therapy may a
patient with AAA
be on?
Statins: Decrease C-reactive protein (CRP)
and matrix metalloproteinase-A (MMP-A)
Tetracyclines: Inhibit MMP-9
Aneurysms demonstrate decreased growth
rates at 6 and 12months.
ACE-I: Decrease risk of rupture
ARB: Decrease rate of formation and
expansion
High Yield History
What factors are
associated with
AAA?
Smoking, increasing age, coronary artery
disease, high cholesterol, hypertension,
peripheral vascular disease, and family history
What are
the major
complications of
AAA?
Rupture and distal embolization
What are the risk
factors that are
associated with
AAA rupture?
Large diameter (> 5cm), recent rapid
expansion, poorly controlled hypertension,
and COPD
What is the most
common etiology
of AAA?
Atherosclerosis. AAA is the result of a
combination of inflammation, smooth muscle
cell apoptosis, and extracellular matrix
protein degeneration. This ultimately results
in subintimal fibrosis and decreased delivery
of oxygen and nutrients to the aortic wall.
Combined with shear stress of hypertension
on the vessel wall and within the adventitial
vasa vasorum, gradual wall degeneration and
expansion occur.
17
Abdominal Aortic Aneurysms
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