title: Radiological Evaluation of Abdominal Endovascular Aortic Aneurysm Repair.
abstract: Endovascular aortic aneurysm repair (EVAR) is an alternative to open surgical repair of aortic aneurysms offering lower perioperative mortality and morbidity. As experience increases, clinicians are undertaking complex repairs with hostile aortic anatomy using branched or fenestrated devices or extra components such as chimneys to ensure perfusion to visceral branch vessels whilst excluding the aneurysm. Defining the success of EVAR depends on both clinical and radiographic criteria, but ultimately depends on complete exclusion of the aneurysm from the circulation. Aortic stent grafts are monitored using a combination of imaging modalities including computed tomography angiography (CTA), ultrasonography, magnetic resonance imaging, plain films, and nuclear medicine studies. This article describes when and how to evaluate aortic stent grafts using each of these modalities along with the characteristic features of several of the main stent grafts currently used in clinical practice. The commonly encountered complications from EVAR are also discussed and how they can be detected using each imaging modality. As the radiation burden from serial follow up CTA imaging is now becoming a concern, different follow-up imaging strategies are proposed depending on the complexity of the repair and based on the relative merits and disadvantages of each imaging modality.
authors.affiliation: Department of Interventional Radiology, Stanford University, Stanford University Medical Center, Palo Alto, California, USA.
authors.forename: Avnesh S
authors.initials: AS
authors.lastname: Thakor
authors.affiliation: Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Tanner
authors.affiliation: Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Shao J
authors.initials: SJ
authors.lastname: Ong
authors.affiliation: Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Ynyr
authors.initials: Y
authors.lastname: Hughes-Roberts
authors.affiliation: Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Ilyas
authors.affiliation: Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Claire
authors.initials: C
authors.lastname: Cousins
authors.affiliation: Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Teik C
authors.initials: TC
authors.lastname: See
authors.affiliation: Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Darren
authors.initials: D
authors.lastname: Klass
authors.affiliation: Department of Interventional Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom. Electronic address: andrew.winterbottom@addenbrookes.nhs.uk.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Winterbottom
mesh_terms: D001014:Aortic Aneurysm / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D003952:Diagnostic Imaging; D057510:Endovascular Procedures; D006801:Humans; D011474:Prosthesis Design; D015607:Stents
keywords: Aortic aneurysm; Computed tomography; Endovascular aortic aneurysm repair; Fenestrated; Magnetic resonance imaging; Nuclear medicine; Surveillance; Ultrasound; X-ray