1. The document discusses various vascular signs and conditions seen on angiography related to neurofibromatosis, adventitial cystic disease, aneurysms, and endovascular repair of abdominal aortic aneurysms. 2. Key signs discussed include the string of beads sign seen in fibromuscular dysplasia, adventitial cystic disease affecting the popliteal artery, and various types of endoleaks seen after endovascular aneurysm repair. 3. Different types of vascular malformations are also summarized, including arteriovenous malformations, fistulas, venous malformations, and sinus pericarnii.

1. Vascular signs
Dr. Dalia El Saied, MD

2. Child with neurofibromatosis / hypertension
causes
NF 1 ---- RAS.
NF 2 ---- usually associated with pheochromcytoma.

3. Internal carotid angiography
AP LA
T

4. Vertebrobasilar angiogrpahy

5. Mesenteric angiography

6. SMA branches

7. IMA branches

10. String of beads sign = FMD

11. Paget Schroetter syndrome
(effort thrombosis of SCV/ thoracic outlet $/ arm swelling)

12. Median arcuate ligament syndrome
Hairpin curve sign

13. Mid-aortic syndrome
 Child.
 RAS (at ostium of renal a)
 Vascular hypertension.
 Mid aortic stenosis.
= Neurofibromatosis
type1.

14. Nutcracker syndrome
Compression of the left renal vein between the (SMA) - Congested left gonadal vein.

15. SMA syndrome …Compression of third part of duodenum by SMA.

16. May Thurner syndrome
Compression of the left common iliac vein by the right common iliac artery

17. Selective gonadal venography.
Venography……. caliber increased as we go distal.
Arteriography…. caliber decreased as we go distal.

18. Testicular varicocele embolization
Materials used
• Coils (solid) / this case.
• PVA (particles).

19. Embolizing materials
Temporary … Gel foam …… e.g: GIT bleeding
Permanent …
 PVA (particles).
 Onyx (liquid).
 Coils (solid).

20. 7 sign (Lt ICA)
reverse 7 sign (if on the Rt side)
Aberrant ICA

21. Adventitial cystic disease
- Affects the peripheral vessels.
- Often in the femoral region.
- It causes extrinsic compression :-
- Of the artery:- claudication and
pain.
- Of the vein (rare):- leads to
swelling of the lower limb.

22. Adventitial cystic disease
Cyst is encasing the vessel (femoral vein).

23. Scimitar sign
Adventitial cystic disease
Lateral displacement and stenosis of the popliteal
artery in conventional , CT or MR angiography.

24. Adventitial cystic disease
Cysts are believed to be due to
repetitive microtrauma or ganglions
especially that they are sometimes
connected with the joint space.
Classic site:- popliteal artery.
D.D:- Popliteal entrapment syndrome.

25. Flow-related aneurysm

26. Flow related aneurysm
** Proximal flow Related aneurysm
- Located on the vessel or branch points of the
circle of Willis or proximal to it (i.e. ICA, ACA, PPCA,
A1 or P1, VA or BA)
** Distal flow related aneurysm
- More distal locations beyond the circle of Willis.

27. Proximal Flow related aneurysm

28. Distal Flow related aneurysm

29. Intranidal aneurysm

30. Non flow related aneurysm

31. Vascular malformations
AVM
(Nidus of vessels
through which
arteriovenous
shunting occurs).
AVF
(An abnormal
connection between
an adjacent artery
and vein).
VOG
(Median
prosencephalic
arteriovenous
fistula)
High Flow

32. Low flow
Venous
malformation
/cavernoma.
Capillary
telangectasia
(Cluster of
enlarged
capillaries with
interposed
parenchyma)
DVA Sinus
pericarnii
(Communication
between dural sinuses
and extracranial
venous structures)

33. Vein of Gallen malformation
Median prosencephalic vein (MPV) (a precursor of the vein of Galen)
The MPV fails to regress and becomes aneurysmally dilated. It drains via the straight sinus or
a persistent falcine sinus, and the vein of Galen does not form.

34. Diffuse nidus type AVM (Old name)
Cerebral proliferative angiopathy

35. Large areas of parenchymal
involvement, (entire lobe or even a
hemisphere)
** The characteristic features :

36. Normal feeder size (or moderately
enlarged).
Fuzzy nidus (not well circumscribed).

37. Lack of dominant feeder

38. Stenosis of feeder arteries is often present

39. Scattered “puddling” of contrast material in the widespread
nidus
No dominant arterial feeder identified.

40. Absence of early venous drainage.
( which helps to differentiate CPA from a classical cerebral AVM).

41. Impeding rupture aortic aneurysm
High attenuating crescent sign
 Hyperdense crescent indicating acute intramural
hematoma.

42. Tangential calcium sign
Calcium is pointing out away (Arrow)

43. Draped aorta sign
 Indistinct posterior aortic wall.
 the posterior aorta follows the spinal contour
on one or both sides.

44. Aortic aneurysm rupture
Aortoduodenal fistula
Intravenous contrast in the intestinal
lumen.

45. EVAR (endovascular aneurysm repair)
Complications:-
 Perigraft infection.
 Limb thrombosis
 Stent migration.
 Endoleak

46. Stent graft complications
Perigraft infection. Limb thrombosis. Graft migration. Endoleak.

47. Type I Endoleak
Located proximal (Black arrow) or distal to the
stent-graft.

48. Flow of blood into the aneurysm sac through branch vessels such as lumbar arteries or a patent inferior
mesenteric artery
Type II Endoleak (the most common)

49. Tear in the body of the stent-graft.
Type III Endoleak

50. Too many pores in the graft / diffuse
endoleak.
Type IV Endoleak