From the Guidelines
A follow-up CTA for aortic aneurysm should be performed based on the type of repair, with specific guidelines for open repair and endovascular repair, as outlined in the 2024 ESC guidelines 1. The frequency of follow-up CTA depends on the type of aneurysm and repair method.
- For thoracic aortic aneurysm (TAA) after open repair, a CTA is recommended within 1 month, and then yearly for the first 2 post-operative years, and every 5 years thereafter if findings are stable 1.
- For TAA after TEVAR (thoracic endovascular aortic repair), follow-up imaging is recommended at 1 and 12 months post-operatively, then yearly until the fifth post-operative year if no abnormalities are documented 1.
- For abdominal aortic aneurysm (AAA) after open repair, the first follow-up imaging is recommended within 1 post-operative year, and then every 5 years thereafter if findings are stable 1.
- For AAA after EVAR (endovascular aortic repair), follow-up imaging is recommended with CTA (or CMR) and DUS/CEUS at 1 month and 12 months post-operatively, then, if no abnormalities are documented, DUS/CEUS is recommended every year, repeating CTA or CMR every 5 years 1. It is essential to adhere to these guidelines to ensure optimal monitoring and management of aortic aneurysms, as they can grow slowly and silently until they reach a critical size where the risk of rupture increases dramatically, and rupture carries a high mortality rate. Key factors to consider in the management of aortic aneurysms include:
- Size and growth rate of the aneurysm
- Type of repair (open or endovascular)
- Presence of any abnormalities or complications
- Patient's overall health and medical history By following the recommended guidelines and considering these key factors, healthcare providers can provide optimal care and management for patients with aortic aneurysms, reducing the risk of morbidity and mortality, and improving quality of life.
From the Research
Aorta Aneurysm CTA Follow-up
- The follow-up for aorta aneurysm using CTA is crucial for detecting potential complications, such as endoleaks, which can predispose the aorta to rupture 2.
- Triple-phase CT angiography (CTA) within 30 days after endovascular aneurysm repair (EVAR) is necessary to triage patients appropriately and guide future imaging 2.
- Patients without endoleak on initial CTA can be monitored with annual duplex ultrasound, while patients with type I or type III endoleaks should be referred for intervention 2.
- The risk of rupture increases with the diameter of the aneurysm, and modern functional imaging techniques, such as PET, CT, and MRI, may help assess rupture risk 3.
- Surveillance with various imaging tests, including CTA, is critical before and after intervention to guide treatment for thoracic aortic aneurysm 4.
- CTA is highly accurate in the diagnosis of suspected rupture of abdominal aortic aneurysm (AAA), with a sensitivity of 98.3% and specificity of 94.9% 5.
Imaging Modalities
- CTA is the preferred imaging modality for surveillance after EVAR, while MR angiography should be used primarily as a problem-solving modality or in patients with contraindications to contrast media or radiation 2.
- Duplex ultrasound can be used for annual monitoring of patients without endoleak on initial CTA 2.
- PET, CT, and MRI may be used to assess rupture risk in patients with abdominal aortic aneurysm 3.
Treatment and Management
- Elective repair of AAA with open surgery or endovascular aortic repair (EVAR) should be considered to prevent AAA rupture 3.
- Beta-blockers are considered first-line therapy for aortic aneurysms, but they do not significantly influence aortic aneurysm growth 6.
- Medical management is also important for patients with thoracic aortic aneurysm, and surveillance with imaging tests is critical to guide treatment 4.