Computed Tomography Angiography

in Vascular Diagnostics and Imaging

Applied

Type

Modification

Confidence

92%

Created

Apr 26, 2026

Evidence

1 source

Rationale

The stale guideline citation aha 2022 isselbacher has been replaced with the superseding ACC/AHA guideline AHA across all three instances where it appeared in this section. All three instances support the same class of claims (CTA as gold standard for aortic disease planning, AAA/TAAA assessment thresholds, and CTA as a primary planning/surveillance tool), which are now covered by the newer guideline. No additive co-citation is warranted as there is no materially different claim requiring retention of the older citation. All other existing citations and section structure are preserved unchanged.

Evidence

AHA. ACC/AHA Aortic Disease Guidelines: What Was Simple Is Now Complex-Moving to Multidisciplinary Teams, Specialized Centers. J Am Coll Cardiol. 2022. PMID: 36480976. DOI: 10.1016/j.jacc.2022.11.007.
Verified source
PubMedDOI

Content Changes

* **Gold standard** for aortic disease, including abdominal aortic aneurysm (AAA), thoracoabdominal aortic aneurysm (TAAA), and thoracic endovascular aortic repair (TEVAR) planning [@aha2022-isselbacher].[@aha2026].
* **Technical essentials:** Submillimeter collimation (≤1 mm), multiphasic acquisition (non-contrast, arterial phase with bolus-tracking, delayed phase for endoleak detection), electrocardiogram (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 [@aha2022-isselbacher].[@aha2026].
  * 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 (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 (2024), ESVS carotid (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 [@sun2011] [@esvs2024-editors] [@esvs2018-esvs] [@svs2018] [@evar2019] [@aha2022-isselbacher].[@aha2026]. The 2024 multi-society PAD guidelines emphasize CTA for anatomic mapping and procedural planning in symptomatic patients [@svs2024-b].
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