Simultaneous aortic and coronary assessment in abdominal aortic aneurysm patients by thoraco-abdominal 64-detector-row CT angiography: estimate of the impact on preoperative management: a pilot study.
OBJECTIVE
To estimate the influence of information on the coronary arteries obtained from routine thoraco-abdominal CT angiography (CTA) on pre-operative clinical management in abdominal aortic aneurysm (AAA) patients.


METHODS
Twenty-eight AAA patients underwent pre-operative thoraco-abdominal electrocardiography (ECG)-gated 64-detector-row CTA to evaluate aortic pulsatility for prosthesis size matching. Retrospectively, the coronaries were reconstructed from the same data set and scored on a per segment basis for stenosis (0%, <or=50% or >50%) and grading confidence (poor, adequate or high). An experienced cardiologist was presented information on patient characteristics obtained from patient records and CTA findings. Suggested changes in European Society of Cardiology guidelines based patient management based on CTA information were scored.


RESULTS
On CTA, 17 patients (61%) had significant coronary disease (>50% stenosis) including left main (n=4), single (n=7) and multiple (n=6) vessel disease. Grading confidence was adequate or high in 86% of proximal and middle segments. Based on CTA findings, patient management would have been changed in 4 out of the 28 patients (14%; 95% CI 1-27%) by adding coronary angiography (n=4). In five patients who underwent coronary artery bypass grafting previously, CT did not change management but confirmed graft patency.


CONCLUSIONS
Information on coronary pathology and coronary bypass graft patency can be readily obtained from thoraco-abdominal CTA and may alter pre-operative patient management, as shown in 14% of AAA patients in our study.
Budde
R P J
RP
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. rbudde@umcutrecht.nl
Huo
F
F
Cramer
M J M
MJ
Doevendans
P A F M
PA
Bots
M L
ML
Moll
F L
FL
Prokop
M
M
D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000453:epidemiology; D019917:Blood Vessel Prosthesis Implantation; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011300:Preoperative Care; D017755:Prosthesis Fitting; D011673:Pulsatile Flow