When Echocardiography Is Challenging in Localizing Bioprosthetic Aortic Regurgitation: Dye Don't Lie.

Transesophageal echocardiography is the main imaging modality for localizing and quantifying prosthetic aortic regurgitation. We describe a case of bioprosthetic aortic paravalvular leak (PVL) where transesophageal echocardiography was inadequate; aortic root angiography and computed tomography fusion were critical in diagnosing and guiding closure. Multimodality imaging can be pivotal in localizing PVL and guiding transcatheter PVL closure. (Level of Difficulty: Intermediate.).

Secondary aortoenteric fistula-A fatal rare case involving the rectum.

Aortoenteric fistula (AEF) is a rare but potentially fatal condition causing massive gastrointestinal bleeding. It is defined as fistulous communication between the gastrointestinal tract and the aorta which is sub classified into primary and secondary. Primary AEF refers to communication between a native aorta and the gastrointestinal tract. Secondary AEF is a communication between a reconstructed aorta, which includes open or endovascular repair, with the gastrointestinal tract. We herein describe an unusual case of secondary AEF in an 88-year-old gentleman. Our case is unusual as secondary AEF involving the rectum has rarely been reported in the literature.

"Distal bright vessel sign" - Novel radiological sign of pulmonary thromboembolism.

We describe a novel radiological sign of pulmonary thromboembolism on computed tomography aortic angiogram. It consists of focal hyperenhancement of pulmonary arteries distal to the pulmonary thrombus, while the thrombus itself remains occult and the rest of pulmonary arteries are hypoattenuating. The sign was observed on computed tomography aortic angiograms in 2 patients assessed for suspected acute aortic syndrome. Pulmonary emboli were subsequently confirmed with computed tomography pulmonary angiography.

Uso de anhidrido carbónico como medio de contraste en la arteriografía y en ultrasonido intravascular en el implante endovascular de prótesis en aneurisma de aorta abdominal en paciente con insuficiencia renal: Reporte de caso / Use of carbon dioxide as a contrast medium for arteriography and intravascular ultrasound in endovascular prothesis of an abdominal aneurism in a patient with renal insufficiency: A case report

El EVAR (endovascular aortic replacement) es una técnica mínimamente invasiva para el tratamiento de los aneurismas de aorta abdominal (AAA). A pesar de ser una técnica muy útil en pacientes complicados, se ve restringida en pacientes con enfermedad renal crónica avanzada (ERCA) y en alérgicos a los medios de contraste yodados usados para el procedimiento. El objetivo del reporte fue describir el uso seguro y eficaz de la arteriografía con CO combinada con IVUS (intravascular ultrasound) en el implante de prótesis endovasculares para AAA en un paciente con ERCA y alérgico a los contrastes yodados. Se realizó la recopilación de datos de historia clínica para la descripción del procedimiento y resultados postoperatorios. El uso de la arteriografía con CO y el IVUS en el EVAR constituye una alternativa útil en pacientes que presentan AAA con ERCA y alérgicos al contraste yodado, con resultado post operatorio adecuado.

The endovascular aortic replacement (EAR) is a minimally invasive technique for the treatment of abdominal aortic aneurisms. Despite of being a very useful technique it is restricted in patients with advanced chronic kidney disease and in patients allergic to iodine based contrast. The objective of this report is to describe the safe and effective use of arteriography using carbon dioxide combined to intravascular ultrasound in the endovascular aortic replacement of an aortic aneurism in a patient with renal insufficiency and history of allergy to iodine based contrasts. A review of the clinical chart of a patient who underwent this procedure was performed.

Trans-catheter closure of a large aneurysm in coarctation of abdominal aorta.

•Here, we are presenting a very rare case of coarctation of abdominal aorta where a transcatheter closure by a vascular plug of the feeding collateral to a large aneurysm has been done. To the best of our knowledge, this mode of therapy has never been described in persons with coarctation of abdominal aorta.•Aneurysms in patients with an abdominal coarctation are not well recognized. This is probably the only case being reported where transcatheter closure of the feeding vessel to the aneurysm has been successfully performed.•In this case, aneurysm was closed by a vascular plug only to prevent sudden rupture and death, and no attempt was made for stenting or dilatation of the atretic segment as the segment was long and no direct connection could be noted between upper and lower segments. The incidence of coarctation of the abdominal aorta is rare and the possibility of aneurysms in coarctation of the abdominal aorta is very rare compared to coarctation of the descending thoracic aorta. Thus, this case is being reported in view of the extreme rarity of the problem.

Aortic dual-energy CT angiography with low contrast medium injection rate.

The contrast medium (CM) induced nephropathy required new CT imaging protocol. This study evaluated the feasibility of low contrast medium (CM) volume and injection flow using aortic dual-energy CT (DECT) angiography with non-linear blending technique. Sixty patients were randomly assigned to two groups: control group (n=30), single-energy CT 70 ml CM at injection rate of 5 ml/s; study group (n=30), DECT mode, 0.5 ml per kg of patient weight CM at injection rate=(weight × 0.5 ml/kg)/(4+scan time). Non-linear blending technique was used for dual-energy images. Mean attention, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of aorta were compared. The level of visible renal artery branches was scored. There was no significant difference between the two groups in the mean aortic attention, SNR and CNR (all P > 0.05). Significant difference was showed in CM injection rate (p < 0.001) and volume (P < 0.001). The renal artery score had no statistically significant difference (P=0.771). Compared conventional scan and CM injection protocol, DECT with non-linear blending technique maintained the image quality of aortic CT angiography with reduced CM volume and flow rate, which could reduce the risks associated with CM injection.