Because most thoracoabdominal aortic repairs are complex, the need for routine surveillance after treatment is crucial, and often, lifelong follow-up is recommended. A 2016 study of 354 patients undergoing endovascular repair for Thoracoabdominal Aortic Aneurysm or Dissection thoracoabdominal aortic pathology underscores the need for close follow-up, because 36% of patients required further intervention within 36 months, most commonly for endoleak [14]. Typically, follow-up imaging is obtained at 1, 3, and 6 months after intervention to evaluate for endoleak, increase in aortic diameter, incomplete false lumen thrombosis (in dissection), and other procedure complications, and prior studies have shown poor compliance with follow-up with increased risk of aortic rupture in patients with poor follow-up [17,80]. After 6 months, individualized imaging follow-up may be planned based on personal risk factors, with imaging typically at 6 to 12 month intervals. Early studies evaluating the ability of MRA to evaluate for endoleak or other complication after EVAR established MRI as a suitable alternative to CTA [78,85,86]. Direct evidence comparing MRA with IV contrast to other modalities in endoleak identification after endovascular thoracoabdominal aneurysm repair is lacking, but multiple additional studies and meta-analyses have compared MRA with CTA in identifying endoleaks after EVAR [78,79,82,83,85,86]. A meta-analysis by Guo et al [82] in 2016 evaluated 3,853 patients after EVAR with paired scans of different modalities (CTA, MRA, US) obtained within a 1-month period. In 1,694 paired CTA and MRA scans, CTA identified 2 additional endoleaks, whereas MRA identified 42 additional endoleaks [82]. A subsequent meta-analysis in 2018 by Zaiem et al also noted that MRI identified more endoleaks than CTA [84].
Thoracoabdominal Aneurysm or Dissection Treatment Planning and Follow Up. Because most thoracoabdominal aortic repairs are complex, the need for routine surveillance after treatment is crucial, and often, lifelong follow-up is recommended. A 2016 study of 354 patients undergoing endovascular repair for Thoracoabdominal Aortic Aneurysm or Dissection thoracoabdominal aortic pathology underscores the need for close follow-up, because 36% of patients required further intervention within 36 months, most commonly for endoleak [14]. Typically, follow-up imaging is obtained at 1, 3, and 6 months after intervention to evaluate for endoleak, increase in aortic diameter, incomplete false lumen thrombosis (in dissection), and other procedure complications, and prior studies have shown poor compliance with follow-up with increased risk of aortic rupture in patients with poor follow-up [17,80]. After 6 months, individualized imaging follow-up may be planned based on personal risk factors, with imaging typically at 6 to 12 month intervals. Early studies evaluating the ability of MRA to evaluate for endoleak or other complication after EVAR established MRI as a suitable alternative to CTA [78,85,86]. Direct evidence comparing MRA with IV contrast to other modalities in endoleak identification after endovascular thoracoabdominal aneurysm repair is lacking, but multiple additional studies and meta-analyses have compared MRA with CTA in identifying endoleaks after EVAR [78,79,82,83,85,86]. A meta-analysis by Guo et al [82] in 2016 evaluated 3,853 patients after EVAR with paired scans of different modalities (CTA, MRA, US) obtained within a 1-month period. In 1,694 paired CTA and MRA scans, CTA identified 2 additional endoleaks, whereas MRA identified 42 additional endoleaks [82]. A subsequent meta-analysis in 2018 by Zaiem et al also noted that MRI identified more endoleaks than CTA [84].