US Duplex Doppler Aorta Abdomen Duplex US of the abdominal aorta carries the advantages of being a readily obtainable bedside examination for evaluation of the distal thoracic and abdominal aorta. After EVAR, duplex US can be used to evaluate aortic diameter and presence of endoleak, with a good correlation of aortic size with CTA in most patients [76,91]. US Echocardiography Transthoracic Resting TTE allows visualization of the heart and portions of the thoracic aorta. However, portions of the proximal descending thoracic aorta may be poorly visualized with TTE, and examination may be limited by poor acoustic windows, creating the possibility of false-negative examinations in following patients after endovascular thoracoabdominal aortic repair [58]. These characteristics have resulted in a low sensitivity of 31% to 55% for diagnosis of acute type B aortic dissection on TTE [33]. TTE is also limited by the ability to visualize the abdominal aorta to determine the extent of thoracoabdominal aortic pathology. Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection. Aortography Chest Abdomen Pelvis There is no relevant literature regarding the use of aortography in the evaluation of follow-up of open repair of TAAA or dissection. Aortogram with DSA for evaluation of the thoracic and abdominal aorta has a sensitivity of up to 90% and a specificity of 95% for acute aortic syndrome [27]. Although it has the advantage of allowing immediate intervention if an abnormality is identified, aortography is an invasive procedure that is now typically performed for treatment after diagnosis of a new or worsening aortic pathology. CT Chest, Abdomen, and Pelvis With IV Contrast There is no relevant literature regarding venous phase CT chest, abdomen, and pelvis for the follow-up of open repair of TAAA or dissection because most follow-up imaging uses an arterially timed contrast bolus in the form of a CTA (discussed below).
Thoracoabdominal Aneurysm or Dissection Treatment Planning and Follow Up. US Duplex Doppler Aorta Abdomen Duplex US of the abdominal aorta carries the advantages of being a readily obtainable bedside examination for evaluation of the distal thoracic and abdominal aorta. After EVAR, duplex US can be used to evaluate aortic diameter and presence of endoleak, with a good correlation of aortic size with CTA in most patients [76,91]. US Echocardiography Transthoracic Resting TTE allows visualization of the heart and portions of the thoracic aorta. However, portions of the proximal descending thoracic aorta may be poorly visualized with TTE, and examination may be limited by poor acoustic windows, creating the possibility of false-negative examinations in following patients after endovascular thoracoabdominal aortic repair [58]. These characteristics have resulted in a low sensitivity of 31% to 55% for diagnosis of acute type B aortic dissection on TTE [33]. TTE is also limited by the ability to visualize the abdominal aorta to determine the extent of thoracoabdominal aortic pathology. Variant 4: Follow-up after open repair of thoracoabdominal aortic aneurysm or dissection. Aortography Chest Abdomen Pelvis There is no relevant literature regarding the use of aortography in the evaluation of follow-up of open repair of TAAA or dissection. Aortogram with DSA for evaluation of the thoracic and abdominal aorta has a sensitivity of up to 90% and a specificity of 95% for acute aortic syndrome [27]. Although it has the advantage of allowing immediate intervention if an abnormality is identified, aortography is an invasive procedure that is now typically performed for treatment after diagnosis of a new or worsening aortic pathology. CT Chest, Abdomen, and Pelvis With IV Contrast There is no relevant literature regarding venous phase CT chest, abdomen, and pelvis for the follow-up of open repair of TAAA or dissection because most follow-up imaging uses an arterially timed contrast bolus in the form of a CTA (discussed below).