Virtual Angioscopy and 3D Navigation: A New Technique for Analysis of the Aortic Arch after Vascular Surgery

Three-D reconstruction of the aortic arch: Virtual Angioscopy (VA) in “Full navigation” mode shows innominate artery, left common carotid artery (LCA), left vertebral artery (LVA) originating directly from the aortic arch, left subclavian artery (LSA), and descending thoracic aorta.

VA in “Empty navigation” mode after aortic wall subtraction. The stent of a Valiant (Medtronic Vascular) stent-graft does not have any connecting bar between springs.

Follow-up CT scan of an acute type A dissection treated by aortic-root replacement and enbloc reattachment of the SAT. VA precisely locates a tear adjacent to the teflon felt at the level of left subclavian artery.

Follow-up CT scan of a patient treated by stent-graft insertion after reimplantation of SAT into the ascending aorta: coronal cut (top right) shows retrograde dissection of the ascending aorta. VA precisely locates the intimal tear just on the suture line of the bypass to the SAT (top left image), and shows inadequate apposition of the proximal rim of the stent-graft.

Follow-up CT scan of a patient treated by a TEVAR for a traumatic aortic transection: MPR (bottom left) shows an inadequate apposition of the proximal rim of stent-graft at the level of the isthmus, VA additionally shows both the location and distance of the inadequate apposition from the SAT.

Follow-up CT scan of a patient treated by a TEVAR for a traumatic aortic transection: sagittal cut (bottom left), and axial cut (top right) shows an inadequate apposition of the proximal rim of stent-graft, VA shows in a single view the number of stent-graft components involved and allows accurate measurements.

Follow-up CT scan of a patient treated by TEVAR after a frozen elephant-trunk technique: sagittal cut (bottom left), 3D reconstruction (middle left) do not show the compression of the second rim of the stent-graft, which is evidenced by VA. VA measurements are more accurate in 3D, while MPR (bottom left) only allows planar measurements.

Follow-up CT scan of a patient treated by TEVAR for a thoracic aneurysm: VA of stent-graft kinking, while analysis on sagittal MIP (bottom left) cut is less informative.

Follow-up CT scan of a patient treated by TEVAR for a thoracic aneurysm: VA shows inadequate apposition of overlapping stent-graft. The line measurements (pink and red) on VA image are represented by white squares on sagittal MIP (upper left).

VA shows lack of apposition of the proximal rim of various devices after TEVAR.