The importance of imaging assessment before endovascular repair of thoracic aorta.
Indications for and experience with placement of endovascular stent grafts in the thoracic aorta are still evolving. Recent advances in imaging technologies have drastically boosted the role of pre-procedural imaging. The accepted diagnostic gold standard, digital subtraction angiography, is now being challenged by the state-of-the-art computed tomography angiography (CTA), magnetic resonance angiography (MRA) and trans-oesophageal echocardiography (TEE). Among these, technological advancements of multidetector computed tomography (MDCT) have propelled it to being the default modality used, optimising the balance between spatial and temporal resolutions and invasiveness. MDCT angiography allows the comprehensive evaluation of thoracic lesions in terms of morphological features and extent, presence of thrombus, relationship with adjacent structures and branches as well as signs of impending or acute rupture, and is routinely used in these settings. In this article, we review the current state-of-the-art radiological imaging for thoracic endovascular aneurysm repair (TEVAR), especially focusing on the role of MDCT angiography. After analysing the technical aspects for optimised imaging protocols for thoracic aortic diseases, we discuss pre-procedural determinants of candidacy, and how to formulate interventional plans based on cross-sectional imaging.
Rousseau
H
H
Service de Radiologie, CHU Rangueil TSA 50032, 31059 Toulouse Cedex 9, France. rousseau.h@chu-toulouse.fr
Chabbert
V
V
Maracher
M A
MA
El Aassar
O
O
Auriol
J
J
Massabuau
P
P
Moreno
R
R
D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000601:surgery; D015901:Angiography, Digital Subtraction; D001013:Aorta, Thoracic / Q000473:pathology* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery; D001018:Aortic Diseases / Q000175:diagnosis* / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D003952:Diagnostic Imaging / Q000379:methods; D017548:Echocardiography, Transesophageal; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012720:Severity of Illness Index; D015607:Stents; D014057:Tomography, X-Ray Computed; D055815:Young Adult