Tortuous Aorta in Kyphoscoliosis

ABSTRACT: We present a rare case of a tortuous aorta in a patient with kyphoscoliosis and the advantages of using radial angiography in this case.

Case description. A 56-year-old male with kyphoscoliosis was referred to us with exertional angina as his chief complaint. He was scheduled for routine cardiac catheterization through the right femoral artery. During the procedure, pronounced tortuosity of the thoracoabdominal aorta was encountered (Figure 1A). The diagnostic catheter could not be negotiated even with the super-stiff Amplatz wire. Subsequently, the right radial approach was used and the left coronary system was engaged with an AL2 Amplatz catheter and the right coronary artery with JR 3.5 Judkins catheter. The coronary vessels were normal (Figure 1B). The kidneys were placed in the thoracic view (Figure 1C). Computed tomographic aortic angiography revealed hair-pin acute angulation of the thoracic aorta, with no evidence of aneurysm (Figure 1D). This is a rare case of a tortuous aorta in a patient with kyphoscoliosis and highlights the advantages of using radial angiography in such a case. We found that the other vessels were normal, with minor atherosclerotic calcified plaques in the right common iliac artery.

This extreme case demonstrates the benefits of switching to radial access when thoracoabdominal tortuosity cannot be negotiated from the femoral approach.

From the Department of Cardiology, Bombay Hospital Institute of Medical Sciences, Mumbai, India. The authors report no conflicts of interest regarding the content herein. Manuscript submitted June 14, 2010, provisional acceptance given June 29, 2010, final version accepted September 13, 2010. Address for correspondence: Dr. Shalima Gautam, Department of Cardiology, Bombay Hospital, 12 New Marine Lines, Mumbai 400020, India. E-mail: shalima16@rediffmail.com