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 major society guidelines for PAD (2024) and Aortic Disease (2022). These guidelines provide high-level evidence (Class 1 recommendations) for the use of CTA in diagnosis and procedural planning. Abbreviations were expanded on first use as per instructions. Article 3 was excluded as it is a secondary publication of the same 2022/2023 aortic guideline already covered by Article 2.

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.
Verified source
PubMedDOI

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-d].
* **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 the thoracic aorta when assessing root or ascending segments,segments to minimize motion artifacts, standardized contrast delivery (4–6 mL/s) with saline chaser, and iterative reconstruction algorithms to reduce radiation dose.dose [@aha2022-d].
* **Applications:**
  * AAA and TAAA morphology assessment and access vessel evaluation; see [[Aneurysmal Diseases|Ch. 4]] for measurement standards and repair thresholds.
  * endovascular 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 for anatomic assessment in patients being considered for revascularization [@svs2024-g].
* **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), and SVS (2018) guidelines recommend CTA as a primary planning tool,tool with[@esvs2019-aaa] aneurysm[@esvs2018-esvs] and[@svs2018]. post-repairThe imaging2022 surveillanceACC/AHA tailoredAortic toGuideline patientreinforces CTA for comprehensive aortic evaluation and devicesurveillance factors.[@aha2022-d], [@sun2011]while [@esvs2019-aaa]the [@esvs2018-esvs]2024 [@svs2018]ACC/AHA/SVS PAD guideline designates CTA as a Class 1 recommendation for anatomic imaging prior to intervention [@svs2024-g]. [@sun2011] [@evar2019]
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