Compared with CT of the chest, abdomen, and pelvis, evaluation of the chest and abdomen only without imaging of the pelvis may fail to detect changing or new pathology in the pelvic vasculature. If venous phase or unenhanced CT has already been performed, additional imaging with CTA may not be required in some patients. CT Chest and Abdomen Without IV Contrast Compared with CT of the chest, abdomen, and pelvis, evaluation of the chest and abdomen only without imaging of the pelvis may fail to detect changing or new pathology in the pelvic vasculature. If venous phase or unenhanced CT has already been performed, additional imaging with CTA may not be required in some patients. CTA Chest, Abdomen, and Pelvis With IV Contrast CTA is ideal for evaluation after endovascular repair because of its sensitivity in detecting endoleaks, ability to detect changes in aortic diameter, evaluation of false lumen thrombosis, endograft infection, and assessment of branch vessel/stent patency [1,2,77-79]. Because most endovascular repairs of TAAA or dissection 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 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 and increased risk of aortic rupture in these patients with limited imaging 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.
Thoracoabdominal Aneurysm or Dissection Treatment Planning and Follow Up. Compared with CT of the chest, abdomen, and pelvis, evaluation of the chest and abdomen only without imaging of the pelvis may fail to detect changing or new pathology in the pelvic vasculature. If venous phase or unenhanced CT has already been performed, additional imaging with CTA may not be required in some patients. CT Chest and Abdomen Without IV Contrast Compared with CT of the chest, abdomen, and pelvis, evaluation of the chest and abdomen only without imaging of the pelvis may fail to detect changing or new pathology in the pelvic vasculature. If venous phase or unenhanced CT has already been performed, additional imaging with CTA may not be required in some patients. CTA Chest, Abdomen, and Pelvis With IV Contrast CTA is ideal for evaluation after endovascular repair because of its sensitivity in detecting endoleaks, ability to detect changes in aortic diameter, evaluation of false lumen thrombosis, endograft infection, and assessment of branch vessel/stent patency [1,2,77-79]. Because most endovascular repairs of TAAA or dissection 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 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 and increased risk of aortic rupture in these patients with limited imaging 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.