Info

major (> 2 mm)

Type IV

Graft wall porosity (within 30 days of placement)

Endotension increased intrasac pressure without visualized endoleak at delayed CT

Type A with no endoleak

Type B with sealed endoleak

Type C with type I or III endoleak

Type D with type II endoleak

Endotension increased intrasac pressure without visualized endoleak at delayed CT

Type A with no endoleak

Type B with sealed endoleak

Type C with type I or III endoleak

Type D with type II endoleak increase in size should prompt the search for an endoleak [6], which may be treated interventionally. If no leak is detected despite a growth over time (endotension), an occult leak must be suspected. Gd-enhanced MRA is more sensitive to small amounts of contrast material in the aneurysmal sac than CTA.

Aortitis / Arteritis

If there is clinical suspicion of aortitis, MRA is preferred over CTA because patients are frequently younger. Both techniques sensitively detect the wall changes even in the initial stage of the disease.

Takayasu arteritis is a rare disorder that leads to progressive occlusion of the thoracic and abdominal aortic branch vessels. In the acute inflammatory stage, a granulomatous infiltration of the vessel wall occurs that leads to nonspecific signs of fever, weight loss, myalgia, and arthralgia. In the later fibrotic stage, constriction of the vessel wall with stenosis, occlusion (lack of pulse) or aneurysm formation may occur. Type II and III involve the abdomen: type II in the descending and abdominal aorta and its side branches, type III has also the aortic arch and supra-aortic arteries [7]. In the acute stage, there is thickening and enhancement of the vessel wall. The vessel wall takes up contrast substantially, which can already be seen in the arterial phase, but is more prominent in later phases (which also allows for a better differentiation from atherosclerotic wall thickening). Inflammatory wall changes may be detected even if the digital subtraction angiogra-phy (DSA) is normal.

Granulomatous arteritis cannot be distinguished morphologically from Takayasu arteritis, but it can be suspected if the arteries involved are ones that are rarely affected by Takayasu disease. It is commonly bilateral and symmetric, and there is a lack of atherosclerotic changes to account for the vascular narrowing.

Polyarteritis nodosa is characterized by small saccular aneurysms of 1-5 mm size, which can sometimes be detected by thin-section CTA but are best displayed on DSA. Aneurysms can be found in the intrarenal or intra-hepatic branches and the mesenteric side branches. Additional luminal irregularities and stenoses of small arteries are typical. In the kidneys, multiple cortical infarcts may be present.

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