Relative contraindications to TEVAR include inadequate proximal or distal seal zones, aortic size discrepancies with respect to manufacturer guidelines, inadequate access, and extensive circumferential thrombus or atheroma at the desired landing zones [27]. Imaging plays a vital role in the pre- and postintervention assessment of TEVAR patients. Accurate characterization of pathology and evaluation for high-risk anatomic features are necessary in the planning phase, whereas careful assessment for graft stability, aortic lumen diameter, and presence of endoleak are paramount in the follow-up period. Because imaging studies carry inherent risk, careful attention must be paid to utilize the most efficacious study that will limit morbidity to the patient while identifying important complications before they become problematic. One finding that has become increasingly clear is that the thoracic aorta demonstrates dynamic changes after TEVAR. As the natural history of post-TEVAR patients evolves, the importance of these gradual changes will become clearer. For example, up to 73% of patients undergoing repair of acute type B aortic dissection will show aortic growth or new aneurysm at 5 years after TEVAR [14]. Although reintervention is not necessary in all cases, close follow-up is mandatory given the propensity for dynamic vascular changes over time. Therefore, TEVAR should be thought of more as a chronic management tool than as definitive intervention. Thoracic Aorta Interventional Planning and Follow-Up Overview of Imaging Modalities A variety of imaging modalities are available for the evaluation and follow-up of thoracic aortic pathology. Advances in imaging technology over the past 2 decades have greatly expanded the role of noninvasive cross- sectional imaging in the pre- and postintervention periods.
Thoracic Aortic Aneurysm or Dissection Treatment Planning and Follow Up. Relative contraindications to TEVAR include inadequate proximal or distal seal zones, aortic size discrepancies with respect to manufacturer guidelines, inadequate access, and extensive circumferential thrombus or atheroma at the desired landing zones [27]. Imaging plays a vital role in the pre- and postintervention assessment of TEVAR patients. Accurate characterization of pathology and evaluation for high-risk anatomic features are necessary in the planning phase, whereas careful assessment for graft stability, aortic lumen diameter, and presence of endoleak are paramount in the follow-up period. Because imaging studies carry inherent risk, careful attention must be paid to utilize the most efficacious study that will limit morbidity to the patient while identifying important complications before they become problematic. One finding that has become increasingly clear is that the thoracic aorta demonstrates dynamic changes after TEVAR. As the natural history of post-TEVAR patients evolves, the importance of these gradual changes will become clearer. For example, up to 73% of patients undergoing repair of acute type B aortic dissection will show aortic growth or new aneurysm at 5 years after TEVAR [14]. Although reintervention is not necessary in all cases, close follow-up is mandatory given the propensity for dynamic vascular changes over time. Therefore, TEVAR should be thought of more as a chronic management tool than as definitive intervention. Thoracic Aorta Interventional Planning and Follow-Up Overview of Imaging Modalities A variety of imaging modalities are available for the evaluation and follow-up of thoracic aortic pathology. Advances in imaging technology over the past 2 decades have greatly expanded the role of noninvasive cross- sectional imaging in the pre- and postintervention periods.