Optimizing imaging for aortic repair

Imaging is an integral part of an aortic program. Careful preoperative planning is essential to successful evaluation and treatment of aortic pathology. Computed tomography angiography (CTA) is the dominant modality for such preoperative planning. The use of a dedicated workstation for 3D postprocessing is very favorable and is considered mandatory when treating complex aortic pathology. Intraoperative imaging during aortic repair still depends heavily on standard fluoroscopy and angiography. However, the introduction of image fusion has the potential to reduce the use of both contrast and radiation, for the benefit of both patients and operators. Using cross-sectional imaging intraoperatively also has the potential to reduce the need for early imaging follow-up and to reduce the technical failures of endovascular aneurysm repair (EVAR). Imaging follow-up after EVAR has changed dramatically since the introduction of minimally invasive aortic repair. CTA remains the gold standard but a significant shift towards ultrasound surveillance has occurred. With the introduction of newer generation EVAR devices, results have improved and a trend towards less rigorous follow-up is expected.