Computed Tomography Angiography

in Vascular Diagnostics and Imaging

Applied

Type

Modification

Confidence

95%

Created

Mar 20, 2026

Evidence

3 sources

Rationale

The section was updated to include the most recent 2022 Aortic Disease and 2024 Peripheral Artery Disease (PAD) guidelines from major societies (ACC/AHA/SVS). These guidelines reinforce CTA as the primary imaging modality for diagnosis and procedural planning. Abbreviations (TAAA, ECG, PAD) were expanded on their first occurrence within the section to comply with the instructions. The existing structure and citations were preserved while integrating the new evidence.

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
Writing Committee Members, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease. J Thorac Cardiovasc Surg. 2023. PMID: 37389507.
Verified source
PubMedDOI

Content Changes

* **Gold standard** for aortic disease (abdominal aortic aneurysm (AAA), TAAA,thoracoabdominal aortic aneurysm (TAAA), thoracic endovascular aortic repair (TEVAR) planning).planning) [@aha2022-i].
* **Technical essentials:** Submillimeter collimation (≤1 mm), multiphasic acquisition (non-contrast, arterial phase with bolus-tracking, delayed phase for endoleak detection), ECG-gatingelectrocardiogram-gating (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.
  * endovascular aneurysm repair (EVAR) and TEVAR planning and surveillance.
  * Carotid and aortic arch assessment; see [[Cerebrovascular Disease|Ch. 7]] for carotid imaging protocols.
  * Peripheral arterialartery disease mapping.(PAD) mapping for anatomic assessment and revascularization planning [@svs2024-o].
* **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/SVS (2022, 2024) guidelines recommend CTA as a primary planning tool,tool for aortic and peripheral disease, with aneurysm and post-repair imaging surveillance tailored to patient and device factors. [@sun2011] [@esvs2019-aaa] [@esvs2018-esvs] [@svs2018] [@evar2019] [@aha2022-i] [@aha2023-c] [@svs2024-o]
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