Images in Cardiovascular Medicine
Anomaly of the Descending Aorta
Multifurcation and Reunion
Chan-Hee Lee, MD; Jang-Won Son, MD, PhD
A
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52-year-old man was admitted to the emergency department for an ST-segment–elevation myocardial infarction. He did not have any past medical history. We decided
to perform an emergent percutaneous coronary intervention
with the use of a right femoral arterial puncture. Initially, we
failed to advance a 0.035-inch metal guidewire past the level
of the infrarenal aorta. After changing to a 0.035-inch hydrophilic guidewire, we barely could pass the aorta and introduce the coronary catheter. After a successful percutaneous
coronary intervention, we performed an aortogram to verify
the reason why the metal guidewire could not pass the aorta.
The aortogram revealed multiple branching of the infrarenal
aorta without any distal flow limitation (Figure A). There was
no significant pressure gradient between the thoracic aorta
and femoral artery. The distal pulses of both lower extremities were intact. The patient was referred for 3-dimensional
reconstruction computed tomography angiography to better understand the aortic anatomy. The 3-dimensional computed tomography angiography showed a multiple branching
and fenestration of the infrarenal aorta and a reunion at the
level of both common iliac arteries (Figure B, anterior view;
Figure C, posterior view). The inferior mesenteric artery
originated from this branching portion of the aorta without
any flow limitation (Figure B, arrow). A maximum-intensity
projection image showed no significant calcification of the
multifurcated descending aorta (Figure D). There were no
anomalous lesions in the ascending aorta and aortic arch
(Figure E). The axial plane images showed multiple septations of the descending aorta (Figure F, arrow) and proximal
portion of both common iliac arteries (Figure G, arrows). His
ankle-brachial index was 0.85 on the right and 0.78 on the
left, respectively.
Such an aortic anomaly can be asymptomatic, but it can
be problematic during cardiac intervention using the femoral
artery. A comprehensive 3-dimensional reconstruction can
help obtain a proper structural understanding of the aortic
anomaly.
Disclosures
None.
From Division of Cardiology, Yeungnam University Medical Center, Daegu, South Korea.
Correspondence Jang-Won Son, MD, PhD, Division of Cardiology, Yeungnam University Medical Center, 170 Hyunchoong-ro, Nam-gu, Daegu, South
Korea 705-703. E-mail [email protected]
(Circulation. 2015;132:1745-1746. DOI: 10.1161/CIRCULATIONAHA.115.018304.)
© 2015 American Heart Association, Inc.
Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.115.018304
1745
1746 Circulation November 3, 2015
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Figure. A, Aortogram showing multiple branching
of the infrarenal aorta. Three-dimensional reconstruction (3D) computed tomography angiography
showing a multiple branching and fenestration of
the infrarenal aorta, and a reunion at the level of
both common iliac arteries (CIAs; B, anterior view;
C, posterior view). The inferior mesenteric artery
originated from this branching portion of the aorta
without any flow limitation (B, arrow). D, Maximumintensity projection image showing no significant
calcification of the multifurcated descending aorta.
E, 3D reconstruction image of the whole aorta
showing no anomalous lesions in the ascending
aorta and aortic arch. The axial plane images showing multiple septations of the descending aorta
(F, arrow) and proximal portion of both CIAs (G,
arrows).
Anomaly of the Descending Aorta: Multifurcation and Reunion
Chan-Hee Lee and Jang-Won Son
Circulation. 2015;132:1745-1746
doi: 10.1161/CIRCULATIONAHA.115.018304
Downloaded from http://circ.ahajournals.org/ by guest on June 18, 2017
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