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Fig. 1. Intra-operative Angiographic CT (DynaCT, Axiom-Artis, Siemens, Germany): a total of 48 mL of radiographic contrast (Visipaque 320 mg I/mL) at 8 mL/s (96 mL of 50% diluted medium) is injected via a transfemoral 4F pigtail catheter. Angiographic CT parameters, with respiration suspended, are 0.8° increment, 512 matrix projection, 220° total angle, 20°/s, 20 frames/s with 248 projections. The time interval from C arm rotation to automatic generation of images on the monitor is 122 s with an acquisition time of 8 s (4 s delay). Multiplanar reconstructions are performed on a commercially available workstation (Voxar 3D, Barco, Kortrijk, Belgium) with the images being presented as maximum intensity projection images (MIP). The cumulative radiation dose for DynaCT is 123 mGy (Dose Area Product 3574.0 microGY/m2). 3-D rendering: an inverted 16 x 8 mm Dacron® graft is anastomosed to the left common iliac artery (inflow-artery) bypassing onto the superior mesenteric artery and the coeliac trunk with a lazy ‘C’ configuration. Renal arteries are revascularised with separate 6 mm Dacron® grafts anastomosed to each limb of the inflow-graft. Aneurysm exclusion is achieved by the subsequent deployment of Valiant and bifurcated Talent endografts.
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