Noninvasive imaging for planning endovascular aortic procedures

Objective: One of the most fundamental differences between open surgical repair of thoracic aortic disease and treatment by endograft exclusion is the dependency on imaging for all critically important aspects of the endovascular approach. Patient selection and pre-procedure planning for device selection and sizing depend on imaging. Therefore aim of this study was to evaluate the accuracy of the 64-slice MDCT for aortic stent-graft planning.

Methods: 15 consecutive patients with thoracic aortic disease were evaluated for endovascular repair by 64-slice MDCT scans. No additional imaging for planning was performed. The dimensions of the aneurysms, dissections, calcification, and relevant branches of the aorta were measured and evaluated. These data were used for selecting the arterial access for stenting, the configuration, diameter, and length of the endograft.

Results: All examinations were of excellent diagnostic quality. Good visualization of the total aorta, side branches, including origin of the Art. Adamkiewicz was achieved in all cases. In 5 patients additional cardiac procedures were performed simultaneously during stent implantation (n=4 Aortic arch replacement, n=1 Aortic valve replacement. In one patient the Art. axillaris was used for access for stent placement due to acute rupture of an old Type-B aortic dissection. Two patients had major complications (n=1 cerebral vascular accident, n=1 significant access arterial injury).

Conclusion: Reliable measures of aortic anatomy can be obtained by 64-slice MDCT for endograft sizing and therefore CT seems the best modality also for challenging aortic anatomy where small differences in measurements would affect patient or graft selection for endograft treatment.