Kinnel et al [57] evaluated aortoiliac and femoral arteries in their comparative study of 175 patients for abdominal aortic tortuosity and noted abdominal aorta tortuosity in 28 patients (16%) with strong association with the occurrence of a complication (adjusted odds ratio 2.7; 95% CI, 1.1-6.6; P = . 03). CTA Chest, Abdomen, and Pelvis With IV Contrast CTA allows the assessment of vessel size, calcifications, and minimal luminal diameters [58]. In a comparative study of 283 of 588 patients undergoing both contrast CT and angiography, with 35 sheath-related complications, Okuyama et al [23] showed a greater predictive value for vascular complications with contrast CT than angiography by area under the curve (P < . 001): 0.87 (95% CI, 0.82-0.91) versus 0.72 (95% CI, 0.66-0.77). Recent data from the VICTORY registry of 240 patients also showed a role of CTA in assessing tortuosity. In the study, the authors noted a higher incidence of access and bleeding complications in patients with a higher iliofemoral tortuosity score (56 [36.8%] versus 17 [19.3%]; P = . 003). Additionally, in a multivariate logistic regression analysis, only the higher iliofemoral tortuosity score was a significant predictor of the primary endpoint (odds ratio, 2.11; 95% CI, 1.09-4.05; P = . 026) [59]. CTA can also be used to evaluate alternate access sites like direct aortic or subclavian/axillary access. Arnett et al [60] retrospectively evaluated 208 patients undergoing CTA and reported on the compared axillary arteries and demonstrated substantially lower rates of significant stenosis (2% versus 12%, P < . 01) and significantly lower rates of moderate to severe calcification disease (9% versus 64%, P < . 01) than iliofemoral arteries. CTA Chest With IV Contrast CTA of the chest with IV contrast is helpful for patients undergoing TAVR [49] for the assessment of supravalvular aorta.
Preprocedural Planning for Transcatheter Aortic Valve Replacement. Kinnel et al [57] evaluated aortoiliac and femoral arteries in their comparative study of 175 patients for abdominal aortic tortuosity and noted abdominal aorta tortuosity in 28 patients (16%) with strong association with the occurrence of a complication (adjusted odds ratio 2.7; 95% CI, 1.1-6.6; P = . 03). CTA Chest, Abdomen, and Pelvis With IV Contrast CTA allows the assessment of vessel size, calcifications, and minimal luminal diameters [58]. In a comparative study of 283 of 588 patients undergoing both contrast CT and angiography, with 35 sheath-related complications, Okuyama et al [23] showed a greater predictive value for vascular complications with contrast CT than angiography by area under the curve (P < . 001): 0.87 (95% CI, 0.82-0.91) versus 0.72 (95% CI, 0.66-0.77). Recent data from the VICTORY registry of 240 patients also showed a role of CTA in assessing tortuosity. In the study, the authors noted a higher incidence of access and bleeding complications in patients with a higher iliofemoral tortuosity score (56 [36.8%] versus 17 [19.3%]; P = . 003). Additionally, in a multivariate logistic regression analysis, only the higher iliofemoral tortuosity score was a significant predictor of the primary endpoint (odds ratio, 2.11; 95% CI, 1.09-4.05; P = . 026) [59]. CTA can also be used to evaluate alternate access sites like direct aortic or subclavian/axillary access. Arnett et al [60] retrospectively evaluated 208 patients undergoing CTA and reported on the compared axillary arteries and demonstrated substantially lower rates of significant stenosis (2% versus 12%, P < . 01) and significantly lower rates of moderate to severe calcification disease (9% versus 64%, P < . 01) than iliofemoral arteries. CTA Chest With IV Contrast CTA of the chest with IV contrast is helpful for patients undergoing TAVR [49] for the assessment of supravalvular aorta.