Computed Tomography Angiography
Applied
Type
ModificationConfidence
92%
Created
Apr 14, 2026
Evidence
1 source
Rationale
The 2019 ESVS AAA guideline ([@esvs2019-aaa]) has been directly superseded by the 2024 ESVS Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Both support the same claim — that CTA is the primary planning and surveillance tool for AAA — so the stale citation is replaced rather than co-cited. The year reference in the Guidelines prose sentence is updated from '2019' to '2024' accordingly. All other content and citations are preserved unchanged.
Evidence
Content Changes
- Gold standard for aortic disease, including abdominal aortic aneurysm (AAA), thoracoabdominal aortic aneurysm (TAAA), and thoracic endovascular aortic repair (TEVAR) planning (Isselbacher 2022)📄.
- Technical essentials: Submillimeter collimation (≤1 mm), multiphasic acquisition (non-contrast, arterial phase with bolus-tracking, delayed phase for endoleak detection), electrocardiogram (ECG)-gating for thoracic aorta when assessing root or ascending segments, standardized contrast delivery (4–6 mL/s) with saline chaser, and iterative reconstruction algorithms to reduce radiation dose.
- Applications:
- AAA and TAAA morphology assessment and access vessel evaluation; see 4Ch. 4 for measurement standards and repair thresholds (Isselbacher 2022)📄.
- Endovascular aneurysm repair (EVAR) and TEVAR planning and surveillance.
- Carotid and aortic arch assessment; see 7Ch. 7 for carotid imaging protocols.
- Peripheral arterial disease (PAD) mapping (Gaba 2024).
- Surveillance protocols: Baseline computed tomography angiography (CTA) at 30 days post-procedure, follow-up at 12 months, then individualized surveillance based on aneurysm sac behavior and endoleak status. Consider duplex ultrasound or contrast-enhanced ultrasound (CEUS) in patients with stable anatomy or renal insufficiency.
- Limitations: Ionizing radiation exposure and iodinated contrast risks (nephropathy, allergic reactions).
- Guidelines: ESVS AAA (2024), ESVS carotid (2018), and ACC/AHA aortic (2022) guidelines recommend CTA as a primary planning tool, with aneurysm and post-repair imaging surveillance tailored to patient and device factors (Sun 2011)📄 (ESVS 2024) (Naylor 2018)📄 (Chaikof 2018)📄 (Aburahma 2019)📄 (Isselbacher 2022)📄. The 2024 multi-society PAD guidelines emphasize CTA for anatomic mapping and procedural planning in symptomatic patients (Gaba 2024).
Before
- Gold standard for aortic disease, including abdominal aortic aneurysm (AAA), thoracoabdominal aortic aneurysm (TAAA), and thoracic endovascular aortic repair (TEVAR) planning (Isselbacher 2022)📄.
- Technical essentials: Submillimeter collimation (≤1 mm), multiphasic acquisition (non-contrast, arterial phase with bolus-tracking, delayed phase for endoleak detection), electrocardiogram (ECG)-gating for thoracic aorta when assessing root or ascending segments, standardized contrast delivery (4–6 mL/s) with saline chaser, and iterative reconstruction algorithms to reduce radiation dose.
- Applications:
- AAA and TAAA morphology assessment and access vessel evaluation; see 4Ch. 4 for measurement standards and repair thresholds (Isselbacher 2022)📄.
- Endovascular aneurysm repair (EVAR) and TEVAR planning and surveillance.
- Carotid and aortic arch assessment; see 7Ch. 7 for carotid imaging protocols.
- Peripheral arterial disease (PAD) mapping (Gaba 2024).
- Surveillance protocols: Baseline computed tomography angiography (CTA) at 30 days post-procedure, follow-up at 12 months, then individualized surveillance based on aneurysm sac behavior and endoleak status. Consider duplex ultrasound or contrast-enhanced ultrasound (CEUS) in patients with stable anatomy or renal insufficiency.
- Limitations: Ionizing radiation exposure and iodinated contrast risks (nephropathy, allergic reactions).
- Guidelines: ESVS AAA (2019), ESVS carotid (2018), and ACC/AHA aortic (2022) guidelines recommend CTA as a primary planning tool, with aneurysm and post-repair imaging surveillance tailored to patient and device factors (Sun 2011)📄 (Wanhainen 2019) (Naylor 2018)📄 (Chaikof 2018)📄 (Aburahma 2019)📄 (Isselbacher 2022)📄. The 2024 multi-society PAD guidelines emphasize CTA for anatomic mapping and procedural planning in symptomatic patients (Gaba 2024).
After
- Gold standard for aortic disease, including abdominal aortic aneurysm (AAA), thoracoabdominal aortic aneurysm (TAAA), and thoracic endovascular aortic repair (TEVAR) planning (Isselbacher 2022)📄.
- Technical essentials: Submillimeter collimation (≤1 mm), multiphasic acquisition (non-contrast, arterial phase with bolus-tracking, delayed phase for endoleak detection), electrocardiogram (ECG)-gating for thoracic aorta when assessing root or ascending segments, standardized contrast delivery (4–6 mL/s) with saline chaser, and iterative reconstruction algorithms to reduce radiation dose.
- Applications:
- AAA and TAAA morphology assessment and access vessel evaluation; see 4Ch. 4 for measurement standards and repair thresholds (Isselbacher 2022)📄.
- Endovascular aneurysm repair (EVAR) and TEVAR planning and surveillance.
- Carotid and aortic arch assessment; see 7Ch. 7 for carotid imaging protocols.
- Peripheral arterial disease (PAD) mapping (Gaba 2024).
- Surveillance protocols: Baseline computed tomography angiography (CTA) at 30 days post-procedure, follow-up at 12 months, then individualized surveillance based on aneurysm sac behavior and endoleak status. Consider duplex ultrasound or contrast-enhanced ultrasound (CEUS) in patients with stable anatomy or renal insufficiency.
- Limitations: Ionizing radiation exposure and iodinated contrast risks (nephropathy, allergic reactions).
- Guidelines: ESVS AAA (2024), ESVS carotid (2018), and ACC/AHA aortic (2022) guidelines recommend CTA as a primary planning tool, with aneurysm and post-repair imaging surveillance tailored to patient and device factors (Sun 2011)📄 (ESVS 2024) (Naylor 2018)📄 (Chaikof 2018)📄 (Aburahma 2019)📄 (Isselbacher 2022)📄. The 2024 multi-society PAD guidelines emphasize CTA for anatomic mapping and procedural planning in symptomatic patients (Gaba 2024).
Reviewer Notes
Approved after replacement-first stale-guideline regeneration review. Clean same-family replacement of stale guideline citation with the known 2024 ESVS AAA superseding guideline.