Spiral CT Angiography Research Articles

Evaluation with spiral computed tomography angiography after intravascular stent application in atherosclerotic renal artery stenosis

Evaluation with spiral computed tomography angiography after intravascular stent application in atherosclerotic renal artery stenosis

Clinical and computed tomography angiography characteristics of infected vs. non-infected abdominal aortic aneurysm: a comparative study.

The aim of this study was to investigate the clinical and multi-slice spiral computed tomography angiography (MSCTA) characteristics for the diagnosis of infected AAA. This retrospective comparative study included patients who were diagnosed with AAA at our hospital between January 2014 and May 2023. A total of 40 patients were included, comprising 20 with infected AAA and 20 with non-infected AAA. Patients with infected AAA were more likely to be younger (62.9 ± 10.1 vs. 70.0 ± 4.4 years, P = 0.007) and to present with fever [7 (35%) vs. 1 (5%), P = 0.026], pain [15 (75%) vs. 2 (10%), P < 0.001], higher C-reactive protein levels (60.4 ± 57.0 vs. 4.1 ± 2.9mg/l, P = 0.005), and higher erythrocyte sedimentation rates (47.7 ± 23.4 vs. 15.2 ± 8.3mm/h, P < 0.001) compared to those with non-infected AAA. Moreover, those with infected AAA exhibited significantly more eccentric saccular morphology [17 (85%) vs. 1 (5%), P = 0.002], a smaller longitudinal-transverse ratio (1.12 ± 0.33 vs. 2.33 ± 0.54, P = 0.001), thicker peri-aneurysmal soft tissue (2.29 ± 1.48 vs. 0.73 ± 0.55cm, P < 0.001), more lobulated margins [18 (90%) vs. 1 (5%), P = 0.001], lower aortic calcification scores (49 vs. 56, P < 0.001), more pneumatosis [6 (30%) vs. 0 (0%), P = 0.014], more ruptures [15 (75%) vs. 5 (20%), P = 0.002], more blurred peri-abdominal aortic fat spaces [16 (80%) vs. 2 (10%), P = 0.001], more adjacent bone destruction [5 (25%) vs. 0 (0%), P = 0.025], more involvement of the psoas major muscle [8 (40%) vs. 1 (5%), P = 0.005], more lymphadenectasis [8 (40%) vs. 1 (5%), P = 0.020], and less tortuous aortas [2 (10%) vs. 9 (45%), P = 0.034] compared with those with non-infected AAA. The clinical manifestations and MSCTA characteristics may differ between infected and non-infected AAA.

Application of multi-planar reconstruction technique in endovascular repair of aortic dissection

BACKGROUND Endovascular repair of aortic dissection is an effective method commonly used in the treatment of Stanford type B aortic dissection. Stent placement during the operation was one-time and could not be repeatedly adjusted during the operation. Therefore, it is of great significance for cardiovascular physicians to fully understand the branch status, position, angle, and other information regarding aortic arch dissection before surgery. AIM To provide more references for clinical cardiovascular physicians to develop treatment plans. METHODS Data from 153 patients who underwent endovascular repair of aortic dissection at our hospital between January 2021 and December 2022 were retrospectively collected. All patients underwent multi-slice spiral computed tomography angiography. Based on distinct post-image processing techniques, the patients were categorized into three groups: Multiplanar reconstruction (MPR) (n = 55), volume reconstruction (VR) (n = 46), and maximum intensity projection (MIP) (n = 52). The detection rate of aortic rupture, accuracy of the DeBakey classification, rotation, and tilt angles of the C-arm during the procedure, dispersion after stent release, and the incidence of late complications were recorded and compared. RESULTS The detection rates of interlayer rupture in the MPR and VR groups were significantly higher than that in the MIP group (P &lt; 0.05). The detection rates of DeBakey subtypes I, II, and III in the MPR group were higher than those in the MIP group, and the detection rate of type III in the MPR group was significantly higher than that in the VR group (P &lt; 0.05). There was no statistically significant difference in the detection rates of types I and II compared to the VR group (P &gt; 0.05). The scatter rate of markers and the incidence of complications in the MPR group were significantly lower than those in the VR and MIP groups (P &lt; 0.05). CONCLUSION The application of MPR in the endovascular repair of aortic dissection has improved the detection rate of dissection rupture, the accuracy of anatomical classification, and safety.

Defining Vascular Anatomy of Kidney and Variation among Potential Live Kidney Donors Using Spiral Computed Tomographic Angiography

Introduction This study measured the accuracy of spiral computed tomographic angiography (SCTA) in defining renal vascular anatomy and estimating the prevalence of renal vascular anomalies in live kidney donors. MethodsThis prospective clinical study included 400 live-related-donor nephrectomies from June 2017 to December 2023. Renal vascular anatomy was described after SCTA. Reporting included the number of renal arteries and veins. Analysis was done by considering intraoperative findings as “actual” findings and compared to preoperative SCTA images for their prediction. For donated side kidneys, the prevalence of vascular variations was calculated using surgical and SCTA findings. The non-donated side was evaluated using SCTA alone. ResultsFour-hundred live-donor nephrectomies were performed including 326 left and 74 right-sided cases. Of the 400 kidneys harvested, 429 renal arteries were detected out of which 414 arteries (96.5 %) were predicted by SCTA. Fifteen accessory renal arteries (1-2 mm) were identified at nephrectomy, which was not predicted. In two cases, SCTA was reported to have renal arterial stenosis (multiple in one and in mid-part in the other) which turned out to be normal intraoperatively. Similarly, 417 renal veins were detected in 400 harvested kidneys. Out of these, 408 renal veins (97.8 %) were predicted by SCTA. Two renal arteries were found in 161 Kidneys and three renal arteries were found in seven kidneys. In addition, two renal veins were found in 35 kidneys. ConclusionSpiral computed tomographic angiography provided a reliable and accurate assessment of renal vascular anatomy and its variations in live donor nephrectomy. Small accessory arteries were missed occasionally.

Diagnostic value of multi-slice spiral computed tomography angiography for intracranial aneurysm.

To investigate the clinical value of multi-slice spiral computed tomography angiography (MSCTA) in the diagnosis of intracranial aneurysms (ICA). The imaging data of 68 patients suspected of having ICA who were examined in the Department of Radiology of the First Affiliated Hospital of Nanjing Medical University from March 2018 to March 2021 were retrospectively analyzed. MSCTA and digital subtraction angiography (DSA) were performed on each patient, and the MSCTA imaging analysis was compared with DSA. The accuracy of DSA in the diagnosis of ICA was 98.53% (67/68), while the accuracy of MSCTA in the diagnosis of ICA was 97.06% (66/68), with no significant difference in diagnostic accuracy (P > 0.05). There were no significant differences in the diameter of the aneurysm, the width of the aneurysm neck, or the location of the aneurysm in the comparison of the ICA image between DSA and MSCTA (P > 0.05). MSCTA offers high accuracy and has favorable clinical value in the diagnosis of ICA. It is worth popularizing as the recommended examination method in clinical practice.

Imaging Effect and Accuracy Analysis of 64-Slice Spiral CT in the Diagnosis of Coronary Artery Stenosis

Objective: To analyze the imaging effect and accuracy of 64-slice spiral CT in the diagnosis of coronary arterystenosis. Methods: 30 patients with suspected coronary heart disease admitted to our hospital from March 2022 to March 2023 were selected. All patients underwent both 64-slice spiral CT and digital subtraction angiography (DSA). DSA is considered the gold standard for diagnosis, so it was used to analyze the diagnostic performance of 64-slice spiral CT. Results: (1) The diagnostic results of digital subtraction angiography and 64-slice spiral CT was analyzed and compared with each other. The 64-slice spiral CT had an accuracy of 96.67% (29/30), a sensitivity 96.55% (28/29), and a specificity of 100.00% (1/1) in diagnosing coronary artery stenosis. (2) There was no significant difference between 64-slice spiral CT and digital subtraction angiography in the positive detection rate of anterior descending artery lesion, the positive detection rate of left main lesion, the positive detection rate of left circumflex artery lesion and the positive detection rate of right coronary artery lesion (P &gt; 0.05). (3) There was no significant difference between 64-slice spiral CT examination and DSA examination in identifying mild stenosis, moderate stenosis, and severe stenosis of coronary arteries (P &gt; 0.05). Conclusion: 64-slice spiral CT examination can accurately determine the degree of occlusion of coronary arteries, which allows for the accurate diagnosis of coronary artery stenosis.

Marked hemopneumopericardium in a patient with rectal cancer with distant metastasis: a case report

IntroductionHemopneumopericardium defines a condition of combined pathology of weakened, dense blood content (hemopericardium) and air (pneumopericardium) in the pericardial cavity with an air fluid level. It is a rare disease, with only one such case reported in the literature. In this case report, we assessed a patient rectal cancer in addition to hemopneumopericardium, dyspnea, and chest pain.Clinical case reportA 47-year-old Arab woman previously diagnosed with rectal cancer metastasized to bones, lymph nodes, and lungs post-Hartmann procedure reported to the emergency department complaining of worsening dyspnea for 2 weeks, more significantly in the supine position. A productive cough with yellowish sputum characterized this; however, there was no pertinent family or psychological history. Examination of the respiratory system revealed dullness on the left side associated with decreased breath sound. The chest radiograph also revealed marked hydro-pneumopericardium. Spiral computed tomography angiography of pulmonary arteries demonstrated pericardial effusion with the air fluid level at pericardial space, implying hydro-pneumopericardium.Clinical conclusionA successful pericardiocentesis was performed, in which 180 cc of blood-filled pericardial fluid was drained, suggesting the presence of hemopneumopericardium. Hemopneumopericardium has multiple etiologies, yet critical intervention is restricted in patients with cardiac tamponade. Hence, pericardiocentesis could be a definitive treatment.

Application effect of multi-slice spiral CT angiography combined with MRI in the diagnosis of cerebral aneurysm

ABSTRACT To investigate the clinical value of multi-slice spiral computed tomography (CT) angiography (MSCTA) combined with MRI in the diagnosis of cerebral aneurysm. A total of 90 patients with cerebral aneurysms diagnosed by DSA were selected as the subjects of this study. Another 30 patients with cerebral infarction were selected as negative controls (NC). Before diagnosis, all patients underwent comprehensive examination using MSCTA and MRI. The results of the comparison and the clinical data of all patients were retrospectively analyzed. MSCTA and MRI examinations can clearly show the specific location, shape, size and anatomical relationship with surrounding tissues of cerebral aneurysms. MSCTA diagnosed 82 patients and missed or misdiagnosed 8 patients in the 90 patients with cerebral aneurysm. The diagnostic sensitivity and accuracy of MSCTA were 91.1 (82/90) and 89.2 (107/120), respectively. MRI examination diagnosed 87 patients and missed or misdiagnosed 3 patients in the 90 patients with cerebral aneurysm. The diagnostic sensitivity and accuracy of MRI were 96.7 (87/90) and 96.7 (116/120), respectively. The sensitivity and accuracy of MSCTA combined with MRI were 100.0 (90/90) and 99.2 (119/120), respectively. MSCTA combined with MRI can not only display the whole picture of brain tissue, but also display the size, shape and relationship with the parent vessel of the aneurysm. The combination of MSCTA and MRI has high sensitivity and accuracy in diagnosing intracranial aneurysms, which provides a promising diagnostic protocol for patients with aneurysms.

Effect of low density carotid plaque on the development of cerebral small vessel disease in patients with carotid stenosis

Objective: To investigate the correlation between cerebral small vessel disease (CSVD) and carotid low-density plaque on multi-slice spiral CT angiography (MSCTA) in patient with carotid stenosis. Methods: The clinical data of 221 patients with carotid stenosis who admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, from January 2016 to January 2021 were retrospectively analyzed. There were 195 males and 26 females, with the age of (70.0±8.4) years (range: 48 to 88 years). According to MRI, the patients were divided into carotid stenosis combined with CSVD group (the CSVD group) and carotid stenosis without CSVD group (the non-CSVD group). Lowest density in the carotid atherosclerotic plaque area (CAPALD) was analyzed by MSCTA. The t-test, Mann-Whitney U test and Chi-square test were used for comparison between the two groups. Univariate and multivariate Logistic regression analysis were performed on CAPALD and other clinical indicators with CSVD. Receiver operating characteristic (ROC) curves of CAPALD and CAPALD combined with the demographics (sex, age and body mass index) were plotted for predicting CSVD, and the area under the curve (AUC), sensitivity and specificity were calculated. Results: There were 169 patients in the CSVD group and 52 patients in the non-CSVD group. In the CSVD group, 88.8% (150/169) were males and 11.2% (19/169) were females, with the age of (70.5±8.2) years (range: 48 to 88 years). In the non-CSVD group, 86.5% (45/52) were males and 13.5% (7/52) were females, with the age of (68.4±9.1) years (range: 51 to 85 years). CAPALD and the score of Montreal cognitive assessment were lower in the CSVD group than those in the non-CSVD group (21.0 HU vs. 35.0 HU, Z=-3.760, P<0.01; 22.6±3.9 vs. 24.8±3.3, t=-2.064, P<0.05). Multivariate Logistic regression analysis showed that CAPALD was an independent factor for CSVD (OR=1.044, 95%CI:1.020 to 1.070, P<0.01). The AUC of the ROC curve for CAPALD predicting carotid stenosis with CSVD was 0.672 (P<0.01), with cut-off value of 34.5 HU, sensitivity of 82.8%, and specificity of 50.0%. The AUC of ROC curve for CAPALD combined with the demographics predicting CSVD was 0.733 (P<0.01), with sensitivity of 82.9% and specificity of 64.0%. Conclusions: The decreased CAPALD is a risk factor for CSVD in patients with carotid stenosis. The analysis of carotid plaque density by MSCTA may help to identify the patients at high risk of CSVD.

Exploration of the Value of 64-Slice Spiral CT Angiography in the Diagnosis and Differentiation of Intracranial Aneurysms

Exploration of the Value of 64-Slice Spiral CT Angiography in the Diagnosis and Differentiation of Intracranial Aneurysms

A pilot study on preoperative vascular anatomy and clinical application in rectal cancer resection

To assess the utility of preoperatively evaluating the vascular anatomy using multisection spiral computed tomography angiography (CTA) and image fusion technology in the treatment of obese patients undergoing laparoscopic radical resection for rectal cancer. This randomised prospective study included 56 patients who underwent laparoscopic surgery for rectal cancer. Patients were randomly divided into two groups: the fusion imaging group (preoperative CTA and image fusion reconstruction [n=28]) and the control group (not performed CTA and image fusion reconstruction before the operation [n=28]). Duration of surgery was defined as the primary endpoint, and the volume of bleeding, the number of lymph node dissections, conversion to laparotomy, time to recovery of postoperative flatus, length of hospitalisation as well as perioperative complications were defined as secondary endpoints. Compared with the control group, the duration of surgery in the image fusion group was shorter, bleeding volume was reduced, and the number of lymph node dissections was greater (p<0.05); however, there was no significant differences between the two groups regarding time to postoperative flatus recovery, conversion to laparotomy, length of hospitalisation, and perioperative complications (p>0.05). Preoperative assessment of the vascular anatomy was an effective method and avoided some invisible risks during surgery, and resulted in a better therapeutic effect.

Clinical Applications of Multi-slice Spiral CT Angiography (CTA)

Clinical Applications of Multi-slice Spiral CT Angiography (CTA)

Dual-Layer Spectral CTA for TAVI Planning Using a Split-Phase Protocol and Low-keV Virtual Monoenergetic Images: Improved Image Quality in Comparison with Single-Phase Conventional CTA.

Adaptation of computed tomography protocols for transcatheter aortic valve implantation (TAVI) planning is required when a first-generation dual-layer spectral CT scanner (DLCT) is used. The purpose of this study was to evaluate the objective image quality of aortic CT angiography (CTA) for TAVI planning using a split-phase technique with reconstruction of 40 keV virtual monoenergetic images (40 keV-VMI) obtained with a DLCT scanner. CT angiography obtained with a single-phase protocol of a conventional single-detector CT (SLCT) was used for comparison. 75 CTA scans from DLCT were retrospectively compared to 75 CTA scans from SLCT. For DLCT, spiral CTA without ECG-synchronization was performed immediately after a retrospectively ECG-gated acquisition covering the heart and aortic arch. For SLCT, spiral CTA with retrospective ECG-gating was performed to capture the heart and the access route simultaneously in one scan. Objective image quality was compared at different levels of the arterial access route. 40 keV virtual monoenergetic images of DLCT showed a significantly higher mean vessel attenuation, SNR, and CNR at all levels of the arterial access route. With 40 keV-VMI of DLCT, the overall mean aortic attenuation of all six measured regions was 589.6 ± 243 HU compared to 492.7 ± 209 HU of SLCT (p < 0.01). A similar trend could be observed for SNR (23.6 ± 18 vs. 18.6 ± 9; p < 0.01) and CNR (21.1 ± 18 vs. 16.4 ± 8; p < 0.01). No deterioration was observed for vascular noise (27.8 ± 9 HU vs. 28.1 ± 8 HU; p = 0.599). Using a DLCT scanner with a split-phase protocol and 40 keV-VMI for TAVI planning, higher objective image quality can be obtained compared to a single-phase protocol of a conventional CT scanner. · Adaption of TAVI planning CT protocols may be required when using a first-generation dual-layer CT scanner.. · Reconstruction of virtual monoenergetic images at 40 keV improves image quality.. · With a split-phase protocol, the radiation dose is lower compared to a single-phase ECG-gated CT acquisition.. · Mangold D, Salatzki J, Riffel J et al. Dual-Layer Spectral CTA for TAVI Planning Using a Split-Phase Protocol and Low-keV Virtual Monoenergetic Images: Improved Image Quality in Comparison with Single-Phase Conventional CTA. Fortschr Röntgenstr 2022; 194: 652 - 659.

CT- ANGIOGRAPHY BASED STUDY OF VARIATIONS IN BRANCHING PATTERN OF RENAL ARTERY

Objective: The purpose of the present study is to search and detailed the existence and occurrence of anatomical variations of the renal artery by using CT angiography. Materials and Methods: 100 patients visited the Radiology department of S.M.S. Medical College, Jaipur. To cover the whole abdominal aorta in each patient, spiral CT angiography scan was made and thin slices (0.6 mm) axial images was obtained. Both sagittal and coronal images were reconstructed. Results: We found that only 23% patients had classical (Normal) anatomical presentation of Renal artery, whereas in 77% patients, variations existed in the same, using CT angiography method. Conclusion: The different varieties of renal vessels have been experienced with expanding recurrence over past decade. This is because of wide spread utilization of renal angiography and other imaging modalities, as of late. We as anatomist accept that anatomical information on atypical renal courses is significant for all careful and radiological intercessions including the kidneys or it might prompt mistaken translation. KEY WORDS: Vessels, Renal Artery, Angiography, variations.

Diagnostic value of three-dimensional reconstruction with multislice spiral CT angiography in patients with cerebrovascular disease.

Diagnostic value of three-dimensional reconstruction with multislice spiral CT angiography in patients with cerebrovascular disease.

The Role of Spiral CT Pulmonary Angiography in the Diagnosis of Postoperative Complications in Patients with Acute Pulmonary Embolism

The purpose is to explore the effect of iterative model reconstruction (IMR) algorithm on improving quality of spiral computed tomography angiography (SCTA) image and its clinical application in the diagnosis of acute pulmonary embolism (PE) complications. 88 patients with acute PE who visited Chongqing Zhongxian People’s Hospital hospital from October 2017 to October 2019 were selected as the study objects, and their CT values, standard deviation (SD) value of background noise, CT volume dose index, and dose length product of pulmonary artery trunk and the erector spines of the spinal column were measured by spiral CT scanning at the tube voltage of 80 kv and 100 kv, respectively. As for image reconstruction, IMR, IDose4 algorithm in hybrid iterative reconstruction (HIR) and Filtering back-projection (FBP) were utilized. By comparing signal-noise ratio (SNR), contrast-noise ratio (CNR) and figure of merit (FOM), the image quality, radiation dose, sensitivity and specificity of different reconstruction algorithms in diagnosis of acute PE were analyzed. The results showed that the background noise of the IMR reconstruction algorithm was lower than that of IDose4 and FBP, and the difference was statistically significant (P &lt; 0.05). The CT value of IMR reconstruction algorithm was significantly higher than that of IDose4 and FBP reconstruction algorithm, and the difference was not statistically significant (P &gt; 0.05). The SNR and CNR of IMR were significantly higher than those of IDose4 and FBP, and the difference was statistically significant (P &lt; 0.05). The FOM values of IMR were significantly higher than those of IDose4 and FBP, and the differences were statistically significant (P &lt; 0.05). CT volume dose index, dose length product, and effective dose of the 80 kv tube voltage group were all lower than that of the 100 kv tube voltage group, accounting for 49.34%, 50.50%, and 52.53% of the 100 kv tube voltage group. And the FOM of 80 kv tube voltage group was higher than that of 100 kv tube voltage group. The sensitivity and specificity of IMR reconstructed images in diagnosis of acute PE complications were higher than those of reconstructed images of IDose4 and FBP, which were 97.67% and 92.0%, respectively. Therefore, the improved SCTA information technology based on the IMR algorithm has better image quality than the IDose4 and FBP reconstruction algorithms, and the image quality index of low-dose scan (80 kv) of the improved SCTA information technology based on the IMR algorithm is higher than that of normal-dose scan (100 kv).

Study on Sensitivity and Accuracy of Diagnosis of Intracranial Aneurysms Based on 256-Slice Spiral CT Angiography

Objective: To investigate the value of 256-slice spiral CT angiography in the diagnosis and postoperative evaluation of patients with intracranial aneurysms. Methods: A total of 62 patients with intracranial aneurysms diagnosed by neurosurgery in our hospital were randomly collected from 2017.03–2018.11. The MSCTA was performed by labeling intravenous non-ionic contrast agent (iodosyls alcohol). The obtained image was imageprocessed at Sun's stand-alone workstation (Philip256iCT). Observe the position, shape, size of the aneurysm, the relationship between the neck and the artery and the structure of the skull base, and compare with the intraoperative findings to understand the anastomosis between the preoperative and intraoperative. Postoperatively, 28 cases were reviewed, and the surgical results, the patency of the arterial artery, and the presence or absence of aneurysm residual were confirmed. Results: Sixty-two patients with intracranial aneurysms were diagnosed with MSCTA and DSA. A total of 66 aneurysms and multiple aneurysms were found. Of these, 32 patients underwent direct operative MSCTA and 43 underwent craniotomy. Endovascular interventional therapy. The location, shape, size, relationship between the neck and the parental artery of the aneurysm and the DSA performance were basically consistent with MSCTA. No false positive results were found. Postoperative examination of MSCTA in 28 cases, all developed well, the arterial artery was well patency, no residual aneurysm was seen. Conclusion: MSCTA can accurately display the location, shape and size of the aneurysm, the relationship between the neck and the artery and the structure of the skull base. It can be used as an important tool for clinical diagnosis and treatment of aneurysm imaging. An important method for post-review and follow-up.

Clinical Value of Multi-Slice Spiral CT Angiography, Colon Imaging, and Image Fusion in the Preoperative Evaluation of Laparoscopic Complete Mesocolic Excision for Right Colon Cancer: a Prospective Randomized Trial

PurposeTo evaluate the clinical value of CT angiography (CTA), CT colonography (CTC), and image fusion in the preoperative evaluation of laparoscopic complete mesocolic excision (CME) for right colon cancer. MethodsIn this randomized prospective study, 80 patients undergoing laparoscopic CME for right colon cancer were randomly divided into two groups: image fusion [the original images were reconstructed using CTA and CTC, then fused into three-dimensional images of the blood vessels and intestines (n = 40)] and control (without CTA and CTC reconstruction before surgery). All patients underwent plain and enhanced abdominal CT before surgery. ResultsIn the image fusion group, the gastrocolic trunk of Henle was present in 33 cases, and its branches originated from the colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. Among these patients, 5 exhibited the right gastroepiploic vein and superior anterior pancreaticoduodenal vein; 21 exhibited a gastrointestinal trunk consisting of 2 or 3 branches of the right gastroepiploic vein, right colon vein, and middle colon vein; and 7 exhibited 3 or 4 gastro-pancreatic and colon trunks consisting of the right colon vein, middle colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. The correspondence with the anatomy actually observed during surgery was 100%. Compared with the conventional CT group, the duration of the operation in the image fusion group was shorter, with reduced intraoperative bleeding, and more lymph node dissection. There were no significant differences in the incidence of complications and length of hospital stay between the two groups (p > 0.05). ConclusionsFor laparoscopic CME for right colon cancer, CTA, CTC, and image fusion were effective preoperative evaluation methods, which avoided some unseen dangers in the operation process and led to better therapeutic outcomes.

Long Term – Twenty Nine Years – Results of the Conventional Surgical Treatment of the Subclavian Steal Syndrome – A Single Center Experience

Introduction: The aim of the study was to assess the patency rates, symptoms resolution rates and the safety of the surgical procedures performed in the conventional surgical treatment of the subclavian steal syndrome, which is caused by severe atherosclerotic lesions of the proximal part of the subclavian or innominate artery and may result in cerebral or upper extremity ischemia. Vast majority of those lesions may be treated with endovascular methods. However, in particular cases conventional surgical procedure remains the best option. Methods: A retrospective review of 75 patients with subclavian steal syndrome, who underwent conventional surgical treatment in our Department between 1988 and 2019, was performed. The vertebrobasilar insufficiency symptoms that covered: dizziness, vertigo, headache, tinnitus, drop attacks, perioral numbness, visual disturbances and arm claudication were most commonly presented among our study group. The indications for surgical treatment included: 44 subclavian artery occlusions, 18 failed angioplasty procedures, 7 innominate artery stenosis, 3 innominate artery occlusions, one carotid subclavian graft thrombosis and 2 restenoses after multiple transluminal angioplasties with stent implantation. The following vascular procedures were performed: 38 subclavian-carotid transpositions, 16 carotid-subclavian PTFE bypasses, 16 endarterectomies of the subclavian or innominate artery, 4 aorto-subclavian or aorto-innominate artery bypasses and one carotid-subclavian side-to-side anastomosis. During long-term follow-up period each patient underwent clinical examination, blood pressure ratio measurement between upper extremities, ultrasound examination and spiral Computed Tomography angiography at regular intervals. The life table method was used to calculate patency rate, overall survival rate, and symptom-free survival. Results: 30 day primary patency and symptom-free survival were observed in 69 patients (92%). Early thrombosis of subclavian artery with concomitant stroke complicated 3 operations (4%), temporary left phrenic nerve disfunction was observed in 5 cases (6,7%) and lymph leak occurred in 6 patients (8%). In one patient with Marfan syndrome a post-operative dissection of the transposed subclavian artery with the vessel obstruction was observed - despite this partial resolution of symptoms was achieved (1,3%). One patient died due to stroke after transposition complication treatment (1,3%). 49 out of the 75 patients (65,3%) of study group remained under direct supervision during the follow-up period ranging from 1 to over 19 years (12-228 months). 7 stenoses of the subclavian artery (14,3%), one subclavian artery occlusion (2%), one false aneurysm of innominate artery (2%), 6 vertebral artery occlusions (12,2%) and one subclavian dissection were stated (2%). Despite those findings 41 patients (83,6%) remained asymptomatic during the whole follow-up period. Conclusion: 1. Surgical treatment of the subclavian steal syndrome is featured with low mortality rate and relatively small number of complications. 2. Long term patency rate exceeding 80 % combined with good symptom-free survival confirms the efficacy of conventional surgical treatment. 3. Open surgery should be the treatment of choice in case of severe in-stent restenosis or occlusion after endovascular procedures. Disclosure: Nothing to disclose

Preoperative evaluation using multi-slice spiral CT angiography of right-side colon vascular in laparoscopic radical operation for right colon cancer

Objectives: To examine the value of multi-slice spiral CT angiography (MSCTA) in the analysis of anatomical variation and structural classification of right colon vessels. Methods: From August 2015 to August 2017, 198 patients (96 of whom underwent laparoscopic radical resection of right colon cancer) at Department of General surgery of Peking University First Hospital were retrospectively collected, and the results of abdominal enhanced CT scan were collected and three-dimensional reconstruction of blood vessels was performed. There were 104 males and 94 females. The age was 64(27) years (M(Q(R)), range: 19 to 87 years). Right gastroepiploic vein, anterior superior pancreaticoduodenal vein, right colonic vein (RCV), superior right colonic vein, ileocolon artery or vein (ICA or ICV), middle colon artery or vein (MCA or MCV) and Henle trunk were observed and recorded respectively. The anatomical relationship between the positions of blood vessels, the length of Henle trunk and surgical trunk were measured. Results: ICV and ICA were the most constant anatomic structures. The ICV/ICA of all patients came directly from SMV/SMA, 36.9% (73/198) ICV going in front of SMV and 63.1% (125/198) behind SMV. 72.2% (143/198) of the patients had RCV imported into Henle trunk and the rest into SMV. Middle colonic vein (MCV) could be observed in 81.3% (161/198) of the cases. 81.4% (131/161) of MCV were imported into SMV, 16.8% (27/161) into Henle trunk, 1.2% (2/161) into the first jejunal vein and 0.6% (1/161) into the splenic vein. Henle trunk was divided into 4 types, among which the occurrence probability of gastric node and pancreatic trunk was the highest. The dry length of Henle trunk was (0.82±0.39) cm (range: 0.37 to 1.68 cm). The length of surgical trunk was (2.54±0.83) cm (range: 1.57 to 3.95 cm). Accuracy of MSCTA results was 96.9%(93/96). Conclusions: Anatomical variation of blood vessels in the right colon is common. Abdominal CT angiography can accurately determine the anatomical structure of the blood vessels in the right colon.