What Does AARO (Abdominal Aortography) Stand For?
AARO stands for Abdominal Aortography, which is a catheter-based invasive imaging procedure involving direct injection of contrast material into the abdominal aorta to visualize the aortic lumen and its branch vessels. 1, 2
Historical Context and Definition
Abdominal aortography is an invasive angiographic technique that has been used since the 1950s for evaluating the abdominal aorta and its branches, particularly in the assessment of abdominal aortic aneurysms (AAA) and renal artery pathology. 2, 3
The procedure involves catheter insertion (typically via femoral artery access) with direct intra-arterial contrast injection to opacify the abdominal aorta, renal arteries, mesenteric vessels, and iliac arteries. 1, 4
Current Role in Clinical Practice
Abdominal aortography has extremely limited utility in modern AAA management and is NOT recommended for routine diagnosis, surveillance, or pre-intervention planning. 5
Why Aortography Is No Longer Used
The American College of Radiology explicitly states that catheter arteriography has "very limited utility" in pre-intervention evaluation of AAA patients, with its sole remaining indication being patients with significant contraindications to BOTH CT angiography (CTA) and MR angiography (MRA). 5
Aortography is invasive, time-consuming, and carries risks of embolization, perforation, and bleeding that are unacceptable when noninvasive alternatives provide superior information. 5
For AAA screening, there is "no relevant literature to support the use of conventional angiography," making this invasive option inappropriate when ultrasound and CTA are available. 5
Modern Imaging Alternatives
The current standard of care uses noninvasive imaging modalities that have completely replaced aortography:
Ultrasound is the first-line modality for AAA screening and surveillance, with sensitivity and specificity approaching 100%. 5
CT angiography (CTA) is the reference standard for AAA diagnosis and pre-intervention planning, providing high-resolution 3D datasets of the aorta and branch vessels. 5
MR angiography (MRA) serves as an alternative when CTA is contraindicated (contrast allergy, severe renal dysfunction). 5
The Only Remaining Indication
Catheter arteriography may be considered ONLY when a patient has severe renal dysfunction that precludes both CTA and MRA (including non-contrast MRA techniques), AND has other contraindications to MRA such as cardiac pacemakers or severe claustrophobia. 5
Even in severe renal dysfunction, the combination of non-contrast CT with the lower contrast load possible with intra-arterial injection may be preferable to avoid the procedure entirely. 5
Critical Pitfall to Avoid
- Do not order abdominal aortography for routine AAA evaluation—this represents outdated practice that exposes patients to unnecessary procedural risks when superior noninvasive alternatives (ultrasound, CTA, MRA) provide more comprehensive anatomic information without the complications of arterial catheterization. 5