From the Guidelines
After ascending aortic aneurysm repair, CT imaging of the chest is recommended at 1 month, and then yearly for the first 2 post-operative years, and every 5 years thereafter if findings are stable, as stated in the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1. This surveillance schedule is crucial for monitoring complications such as pseudoaneurysm formation, graft issues, progression of disease in untreated aortic segments, and development of new aneurysms. The imaging protocol should include contrast-enhanced CT with thin slices (1-3mm) and multiplanar reconstructions to properly visualize the entire aorta. Some key points to consider:
- For patients with genetic aortopathies (like Marfan syndrome), dissection, or endovascular repairs, the surveillance schedule may need to be intensified, with scans every 3-6 months initially 1.
- The first post-operative scan establishes a new baseline for comparison, while subsequent imaging monitors for any changes or complications.
- For patients with renal insufficiency or contrast allergies, MRI or non-contrast CT may be substituted, as recommended in the guidelines 1.
- Early detection of complications significantly improves outcomes, as up to 10-15% of patients develop complications or require reintervention within 10 years after repair. The most recent and highest quality study, the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1, provides the basis for this recommendation, prioritizing morbidity, mortality, and quality of life as the outcome.
From the Research
Frequency of CT Scans after Repair of Ascending Aortic Aneurysm
- The frequency of computed tomography (CT) scans after repair of an ascending aortic aneurysm is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it is mentioned that echocardiography and CT scans are the main exams used to evaluate the diameter of the ascending aorta and its follow-up 4.
- In asymptomatic patients, conservative treatment with beta-blockers and follow-up by echocardiography once or twice a year is recommended 4.
- CT scans are usually used in acute situations, while MRI is the most appropriate investigation for most patients with chronic aortic disease 5.
- The provided studies focus on the surgical techniques, post-operative complications, and imaging findings after repair of ascending aortic aneurysms, but do not provide a specific frequency for CT scans 2, 3, 6.
Imaging Findings and Follow-up
- The normal range of postoperative imaging findings, including perigraft thickening, flow outside the graft, and thrombus, are described in studies 3.
- Accurate postoperative imaging evaluation requires precise knowledge of the surgical technique performed and its anatomic consequences 3.
- The choice of imaging modality, such as CT or MRI, depends on the specific situation and the patient's condition 5.