Log in

State-of-the-Art Imaging of the Aorta with Respect to Endoluminal Intervention

  • Review
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Acute aortic syndrome, aortic aneurysm and stenotic aortic disease are significant challenges for state-of-the art imaging of the aorta. Over the last decade, advanced imaging methods such as multidetector computed tomography, high-resolution ultrasound including color-coded Doppler and contrast-enhanced B-mode imaging and magnetic resonance imaging have assumed an important role in identifying and describing many of the complex aortic pathologies. They play a fundamental role in decision making for treatment such as endovascular, or open surgical or conservative treatment. In this overview, a systematic description of all present imaging modalities is presented and their respective roles for the entire spectrum of aortic diseases are illustrated and defined in their relevance. Furthermore, future aspects such as virtual reality methods are presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11.

Similar content being viewed by others

References

  1. Beales L, Wolstenhulme S, Evans JA, West R, Scott DJ. Reproducibility of ultrasound measurement of the abdominal aorta. Br J Surg. 2011;98:1517–25.

    CAS  PubMed  Google Scholar 

  2. Hangge P, Pershad Y, Witting AA, Albadawi H, Oklu R. Three-dimensional (3D) printing and its applications for aortic diseases. Cardiovasc Diagn Ther. 2018;8:S19–25.

    PubMed  PubMed Central  Google Scholar 

  3. Crawford ES, Stowe CL, Crawford JL, Titus JL, Weilbaecher DG. Aortic arch aneurysm. A sentinel of extensive aortic disease requiring subtotal and total aortic replacement. Ann Surg. 1984;199:742–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Ishimaru S. Endografting of the aortic arch. J Endovasc Ther. 2004;11(Suppl 2):II62-71.

    PubMed  Google Scholar 

  5. Schumacher H, Eckstein HH, Kallinowski F, Allenberg JR. Morphometry and classification in abdominal aortic aneurysms: patient selection for endovascular and open surgery. J Endovasc Surg. 1997;4:39–44.

    CAS  PubMed  Google Scholar 

  6. Chaer RA, Vasoncelos R, Marone LK, et al. Synchronous and metachronous thoracic aneurysms in patients with abdominal aortic aneurysms. J Vasc Surg. 2012;56:1261–5.

    PubMed  Google Scholar 

  7. Hultgren R, Larsson E, Wahlgren CM, Swedenborg J. Female and elderly abdominal aortic aneurysm patients more commonly have concurrent thoracic aortic aneurysm. Ann Vasc Surg. 2012;26:918–23.

    PubMed  Google Scholar 

  8. Crawford ES, Crawford JL, Safi HJ, et al. Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg. 1986;3:389–404.

    CAS  PubMed  Google Scholar 

  9. Erbel R, Aboyans V, Boileau C, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. the task force for the diagnosis and treatment of aortic diseases of the European society of cardiology (ESC). Eur Heart J. 2014;35:2873–926.

    PubMed  Google Scholar 

  10. Ultee KHJ, Zettervall SL, Soden PA, et al. The impact of endovascular repair on management and outcome of ruptured thoracic aortic aneurysms. J Vasc Surg. 2017;66(343–52):e1.

    Google Scholar 

  11. Marrocco-Trischitta MM, de Beaufort HW, Secchi F, et al. A geometric reappraisal of proximal landing zones for thoracic endovascular aortic repair according to aortic arch types. J Vasc Surg. 2017;65:1584–90.

    PubMed  Google Scholar 

  12. Ueda T, Takaoka H, Raman B, Rosenberg J, Rubin GD. Impact of quantitatively determined native thoracic aortic tortuosity on endoleak development after thoracic endovascular aortic repair. AJR Am J Roentgenol. 2011;197:W1140–6.

    PubMed  Google Scholar 

  13. Litmanovich D, Bankier AA, Cantin L, Raptopoulos V, Boiselle PM. CT and MRI in diseases of the aorta. AJR Am J Roentgenol. 2009;193:928–40.

    PubMed  Google Scholar 

  14. Adriaans BP, Wildberger JE, Westenberg JJM, Lamb HJ, Schalla S. Predictive imaging for thoracic aortic dissection and rupture: moving beyond diameters. Eur Radiol. 2019;29:6396–404.

    PubMed  PubMed Central  Google Scholar 

  15. Stather PW, Dattani N, Bown MJ, Earnshaw JJ, Lees TA. International variations in AAA screening. Eur J Vasc Endovasc Surg. 2013;45:231–4.

    CAS  PubMed  Google Scholar 

  16. Takagi H, Goto SN, Matsui M, Manabe H, Umemoto T. A further meta-analysis of population-based screening for abdominal aortic aneurysm. J Vasc Surg. 2010;52:1103–8.

    PubMed  Google Scholar 

  17. Badger SA, Jones C, McClements J, Lau LL, Young IS, Patterson CC. Surveillance strategies according to the rate of growth of small abdominal aortic aneurysms. Vasc Med. 2011;16:415–21.

    PubMed  Google Scholar 

  18. Aboyans V, Bataille V, Bliscaux P, et al. Effectiveness of screening for abdominal aortic aneurysm during echocardiography. Am J Cardiol. 2014;114:1100–4.

    PubMed  Google Scholar 

  19. Ying AJ, Affan ET. Abdominal aortic aneurysm screening: a systematic review and meta-analysis of efficacy and cost. Ann Vasc Surg. 2019;54(298–303):e3.

    Google Scholar 

  20. Schanzer A, Messina L. Two decades of endovascular abdominal aortic aneurysm repair: enormous progress with serious lessons learned. J Am Heart Assoc. 2012;1:e000075.

    PubMed  PubMed Central  Google Scholar 

  21. Patel R, Sweeting MJ, Powell JT, Greenhalgh RM. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388:2366–74.

    PubMed  Google Scholar 

  22. Powell JT, Sweeting MJ, Ulug P, et al. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Br J Surg. 2017;104:166–78.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Arzani A, Shadden SC. Characterizations and correlations of wall shear stress in aneurysmal flow. J Biomech Eng. 2016;138:0145031–01450310.

    Google Scholar 

  24. Febina J, Sikkandar MY, Sudharsan NM. Wall shear stress estimation of thoracic aortic aneurysm using computational fluid dynamics. Comput Math Methods Med. 2018;2018:7126532.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Frederick JR, Woo YJ. Thoracoabdominal aortic aneurysm. Ann Cardiothorac Surg. 2012;1:277–85.

    PubMed  PubMed Central  Google Scholar 

  26. Safi HJ, Miller CC III. Spinal cord protection in descending thoracic and thoracoabdominal aortic repair. Ann Thorac Surg. 1999;67:1937–9 (discussion 53-8).

    CAS  PubMed  Google Scholar 

  27. Mussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA. Acute aortic dissection and intramural hematoma: a systematic review. JAMA. 2016;316:754–63.

    PubMed  Google Scholar 

  28. Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest. 2002;122:311–28.

    PubMed  Google Scholar 

  29. Chiles C, Carr JJ. Vascular diseases of the thorax: evaluation with multidetector CT. Radiol Clin North Am. 2005;43:543–69.

    PubMed  Google Scholar 

  30. Lempel JK, Frazier AA, Jeudy J, et al. Aortic arch dissection: a controversy of classification. Radiology. 2014;271:848–55.

    PubMed  Google Scholar 

  31. Czerny M, Schmidli J, Adler S, et al. Editor’s choice - current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European association for cardio-thoracic surgery (EACTS) & the European society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg. 2019;57:165–98.

    PubMed  Google Scholar 

  32. Kudo T, Mikamo A, Kurazumi H, Suzuki R, Morikage N, Hamano K. Predictors of late aortic events after Stanford type B acute aortic dissection. J Thorac Cardiovasc Surg. 2014;148:98–104.

    PubMed  Google Scholar 

  33. Weiss G, Wolner I, Folkmann S, et al. The location of the primary entry tear in acute type B aortic dissection affects early outcome. Eur J Cardiothorac Surg. 2012;42:571–6.

    PubMed  Google Scholar 

  34. Dake MD, Thompson M, van Sambeek M, Vermassen F, Morales JP. DISSECT: a new mnemonic-based approach to the categorization of aortic dissection. Eur J Vasc Endovasc Surg. 2013;46:175–90.

    CAS  PubMed  Google Scholar 

  35. Nienaber CA, Kische S, Rousseau H, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6:407–16.

    CAS  PubMed  Google Scholar 

  36. Sommer T, Fehske W, Holzknecht N, et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology. 1996;199:347–52.

    CAS  PubMed  Google Scholar 

  37. Nienaber CA, von Kodolitsch Y, Nicolas V, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med. 1993;328:1–9.

    CAS  PubMed  Google Scholar 

  38. Duran ES, Ahmad F, Elshikh M, Masood I, Duran C. Computed tomography imaging findings of acute aortic pathologies. Cureus. 2019;11:e5534.

    PubMed  PubMed Central  Google Scholar 

  39. Bolger AF. Aortic intramural haematoma. Heart. 2008;94:1670–4.

    PubMed  Google Scholar 

  40. Wu MT, Wang YC, Huang YL, et al. Intramural blood pools accompanying aortic intramural hematoma: CT appearance and natural course. Radiology. 2011;258:705–13.

    PubMed  Google Scholar 

  41. Kitai T, Kaji S, Yamamuro A, et al. Impact of new development of ulcer-like projection on clinical outcomes in patients with type B aortic dissection with closed and thrombosed false lumen. Circulation. 2010;122:S74-80.

    PubMed  Google Scholar 

  42. Nathan DP, Boonn W, Lai E, et al. Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease. J Vasc Surg. 2012;55:10–5.

    PubMed  Google Scholar 

  43. Kuehl H, Eggebrecht H, Boes T, et al. Detection of inflammation in patients with acute aortic syndrome: comparison of FDG-PET/CT imaging and serological markers of inflammation. Heart. 2008;94:1472–7.

    CAS  PubMed  Google Scholar 

  44. Azizzadeh A, Keyhani K, Miller CC III, Coogan SM, Safi HJ, Estrera AL. Blunt traumatic aortic injury: initial experience with endovascular repair. J Vasc Surg. 2009;49:1403–8.

    PubMed  Google Scholar 

  45. Azizzadeh A, Villa MA, Miller CC III, Estrera AL, Coogan SM, Safi HJ. Endovascular repair of ruptured abdominal aortic aneurysms: systematic literature review. Vascular. 2008;16:219–24.

    PubMed  Google Scholar 

  46. Schulz CJ, Böckler D, Krisam J, Geisbüsch P. Two-dimensional-three-dimensional registration for fusion imaging is noninferior to three-dimensional- three-dimensional registration in infrarenal endovascular aneurysm repair. J Vasc Surg. 2019;70:2005–13.

    PubMed  Google Scholar 

  47. Hertault A, Rhee R, Antoniou GA, et al. Radiation dose reduction during evar: results from a prospective multicentre study (the REVAR study). Eur J Vasc Endovasc Surg. 2018;56:426–33.

    PubMed  Google Scholar 

  48. Weisz G, Smilowitz NR, Metzger DC, et al. The association between experience and proficiency with robotic-enhanced coronary intervention-insights from the PRECISE multi-center study. Acute Card Care. 2014;16:37–40.

    PubMed  Google Scholar 

  49. Li MM, Hamady MS, Bicknell CD, Riga CV. Flexible robotic catheters in the visceral segment of the aorta: advantages and limitations. J Cardiovasc Surg (Torino). 2018;59:317–21.

    Google Scholar 

  50. Tystad KL, Tangen GA, Manstad-Hulaas F. Electromagnetic navigation versus fluoroscopy in aortic endovascular procedures: a phantom study. Int J Comput Assist Radiol Surg. 2017;12:51–7.

    Google Scholar 

Download references

Funding

This study was not supported by any funding.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Götz M. Richter.

Ethics declarations

Conflict of interest

The author declares that he has no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

For this type of study, informed consent is not required.

Consent for Publication

For this type of study, consent for publication is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Richter, G.M. State-of-the-Art Imaging of the Aorta with Respect to Endoluminal Intervention. Cardiovasc Intervent Radiol 43, 1745–1755 (2020). https://doi.org/10.1007/s00270-020-02680-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-020-02680-6

Keywords

Navigation