title: State-of-the-art aortic imaging: Part II - applications in transcatheter aortic valve replacement and endovascular aortic aneurysm repair.
abstract: Transcatheter aortic valve replacement (TAVR) as well as thoracic and abdominal endovascular aortic repair (TEVAR and EVAR) rely on accurate pre- and postprocedural imaging. This review article discusses the application of imaging, including preprocedural assessment and measurements as well as postprocedural imaging of complications. Furthermore, the exciting perspective of computational fluid dynamics (CFD) based on cross-sectional imaging is presented. TAVR is a minimally invasive alternative for treatment of aortic valve stenosis in patients with high age and multiple comorbidities who cannot undergo traditional open surgical repair. Given the lack of direct visualization during the procedure, pre- and peri-procedural imaging forms an essential part of the intervention. Computed tomography angiography (CTA) is the imaging modality of choice for preprocedural planning. Routine postprocedural follow-up is performed by echocardiography to confirm treatment success and detect complications. EVAR and TEVAR are minimally invasive alternatives to open surgical repair of aortic pathologies. CTA constitutes the preferred imaging modality for both preoperative planning and postoperative follow-up including detection of endoleaks. Magnetic resonance imaging is an excellent alternative to CT for postoperative follow-up, and is especially beneficial for younger patients given the lack of radiation. Ultrasound is applied in screening and postoperative follow-up of abdominal aortic aneurysms, but cross-sectional imaging is required once abnormalities are detected. Contrast-enhanced ultrasound may be as sensitive as CTA in detecting endoleaks.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany, and Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany.
authors.forename: Fabian
authors.initials: F
authors.lastname: Rengier
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Geisbüsch
authors.affiliation: Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Schoenhagen
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany, and Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Müller-Eschner
authors.affiliation: Institute for Modern Computerized Diagnostics, Gottingen, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Vosshenrich
authors.affiliation: Department of Neurosurgery, Houston Methodist, Houston, Texas, USA.
authors.forename: Christof
authors.initials: C
authors.lastname: Karmonik
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany, and Institute for Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern, Switzerland.
authors.forename: Hendrik
authors.initials: H
authors.lastname: von Tengg-Kobligk
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland OH, USA.
authors.forename: Sasan
authors.initials: S
authors.lastname: Partovi
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis* / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology; D001027:Aortography / Q000379:methods; D006328:Cardiac Catheterization / Q000009:adverse effects; D003198:Computer Simulation; D004452:Echocardiography; D057510:Endovascular Procedures / Q000009:adverse effects; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008955:Models, Cardiovascular; D064847:Multimodal Imaging; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
keywords: Aorta; angiography; aortic diseases; computed tomography; imaging; magnetic resonance imaging