Computed Tomography Angiography

in Vascular Diagnostics and Imaging

Applied

Type

Modification

Confidence

95%

Created

Mar 19, 2026

Evidence

2 sources

Rationale

The section was updated to integrate the most recent clinical practice guidelines for aortic disease (2022) and peripheral artery disease (2024). These guidelines reinforce CTA as the primary imaging modality for planning and surveillance. Additionally, all medical abbreviations (TAAA, ECG, PAD) were expanded on their first use within the section to comply with the required formatting rules.

Evidence

Gornik HL, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease. Circulation. 2024. PMID: 38743805.
Verified source
PubMedDOI
Isselbacher EM, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease. Circulation. 2022. PMID: 36322642.

This guideline provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets.

Verified source
PubMedDOIOpen PDF

Content Changes

* **Gold standard** for aortic diseasedisease, (abdominalincluding abdominal aortic aneurysm (AAA), TAAA,thoracoabdominal aortic aneurysm (TAAA), and thoracic endovascular aortic repair (TEVAR) planning).planning [@aha2022-isselbacher].
* **Technical essentials:** Submillimeter collimation (≤1 mm), multiphasic acquisition (non-contrast, arterial phase with bolus-tracking, delayed phase for endoleak detection), ECG-gatingelectrocardiogram (ECG)-gating for thoracic aorta when assessing root or ascending segments, standardized contrast delivery (4–6 mL/s) with saline chaser, and iterative reconstruction algorithms to reduce radiation dose.
* **Applications:**
  * AAA and TAAA morphology assessment and access vessel evaluation; see [[Aneurysmal Diseases|Ch. 4]] for measurement standards and repair thresholds.thresholds [@aha2022-isselbacher].
  * endovascularEndovascular aneurysm repair (EVAR) and TEVAR planning and surveillance.
  * Carotid and aortic arch assessment; see [[Cerebrovascular Disease|Ch. 7]] for carotid imaging protocols.
  * Peripheral arterial disease mapping.(PAD) mapping [@svs2024-b].
* **Surveillance protocols:** Baseline computed tomography angiography (CTA) at 30 days post-procedure, follow-up at 12 months, then individualized surveillance based on aneurysm sac behavior and endoleak status. Consider duplex ultrasound or contrast-enhanced ultrasound (CEUS) in patients with stable anatomy or renal insufficiency.
* **Limitations:** Ionizing radiation exposure and iodinated contrast risks (nephropathy, allergic reactions).
* **Guidelines:** ESVS AAA (2019) and(2019), ESVS carotid (2018)(2018), and ACC/AHA aortic (2022) guidelines recommend CTA as a primary planning tool, with aneurysm and post-repair imaging surveillance tailored to patient and device factors.factors [@sun2011] [@esvs2019-aaa] [@esvs2018-esvs] [@svs2018] [@evar2019] [@aha2022-isselbacher]. The 2024 multi-society PAD guidelines emphasize CTA for anatomic mapping and procedural planning in symptomatic patients [@svs2024-b].
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