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Abdominal Aortic Aneurysm or Dissection-Interventional Planning and Follow-up

Variant: 1   Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
Procedure Appropriateness Category Relative Radiation Level
CTA abdomen and pelvis with IV contrast Usually Appropriate ☢☢☢☢
CTA abdomen and pelvis without and with IV contrast Usually Appropriate ☢☢☢☢
MRA abdomen and pelvis without and with IV contrast Usually Appropriate O
CT abdomen and pelvis without and with IV contrast Usually Appropriate ☢☢☢☢
US duplex Doppler aorta abdomen Usually Appropriate O
CT abdomen and pelvis with IV contrast May Be Appropriate ☢☢☢
CT abdomen and pelvis without IV contrast and US aorta abdomen with duplex Doppler May Be Appropriate ☢☢☢☢
CT abdomen and pelvis without IV contrast May Be Appropriate ☢☢☢
MRA abdomen and pelvis without IV contrast May Be Appropriate O
US abdomen and pelvis with IV contrast May Be Appropriate O
US aorta abdomen with IV contrast May Be Appropriate O
Aortography abdomen and pelvis Usually Not Appropriate ☢☢☢☢
US abdomen and pelvis Usually Not Appropriate O
Aortography abdomen Usually Not Appropriate ☢☢☢
Radiography abdomen and pelvis Usually Not Appropriate ☢☢☢

Variant: 2   Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
Procedure Appropriateness Category Relative Radiation Level
CTA abdomen and pelvis with IV contrast Usually Appropriate ☢☢☢☢
CTA abdomen and pelvis without and with IV contrast Usually Appropriate ☢☢☢☢
MRA abdomen and pelvis without and with IV contrast Usually Appropriate O
CT abdomen and pelvis without and with IV contrast May Be Appropriate ☢☢☢☢
CT abdomen and pelvis with IV contrast May Be Appropriate ☢☢☢
CT abdomen and pelvis without IV contrast and US aorta abdomen with duplex Doppler May Be Appropriate ☢☢☢☢
MRA abdomen and pelvis without IV contrast May Be Appropriate O
Aortography abdomen and pelvis Usually Not Appropriate ☢☢☢☢
CT abdomen and pelvis without IV contrast Usually Not Appropriate ☢☢☢
US abdomen and pelvis Usually Not Appropriate O
US abdomen and pelvis with IV contrast Usually Not Appropriate O
US duplex Doppler aorta abdomen Usually Not Appropriate O
Aortography abdomen Usually Not Appropriate ☢☢☢
Radiography abdomen and pelvis Usually Not Appropriate ☢☢☢
US aorta abdomen with IV contrast Usually Not Appropriate O

Variant: 3   Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
Procedure Appropriateness Category Relative Radiation Level
CTA abdomen and pelvis without and with IV contrast Usually Appropriate ☢☢☢☢
CTA abdomen and pelvis with IV contrast Usually Appropriate ☢☢☢☢
CT abdomen and pelvis without and with IV contrast Usually Appropriate ☢☢☢☢
MRA abdomen and pelvis without and with IV contrast Usually Appropriate O
CT abdomen and pelvis with IV contrast May Be Appropriate ☢☢☢
CT abdomen and pelvis without IV contrast May Be Appropriate ☢☢☢
CT abdomen and pelvis without IV contrast and US aorta abdomen with duplex Doppler May Be Appropriate ☢☢☢☢
MRA abdomen and pelvis without IV contrast May Be Appropriate O
US abdomen and pelvis with IV contrast May Be Appropriate O
US aorta abdomen with IV contrast May Be Appropriate O
US duplex Doppler aorta abdomen May Be Appropriate O
Aortography abdomen and pelvis May Be Appropriate ☢☢☢☢
Aortography abdomen Usually Not Appropriate ☢☢☢
Radiography abdomen and pelvis Usually Not Appropriate ☢☢☢
US abdomen and pelvis Usually Not Appropriate O

Variant: 4   Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
Procedure Appropriateness Category Relative Radiation Level
CTA abdomen and pelvis without and with IV contrast Usually Appropriate ☢☢☢☢
CTA abdomen and pelvis with IV contrast Usually Appropriate ☢☢☢☢
MRA abdomen and pelvis without and with IV contrast Usually Appropriate O
CT abdomen and pelvis with IV contrast May Be Appropriate ☢☢☢
CT abdomen and pelvis without and with IV contrast May Be Appropriate ☢☢☢☢
CT abdomen and pelvis without IV contrast May Be Appropriate ☢☢☢
CT abdomen and pelvis without IV contrast and US aorta abdomen with duplex Doppler May Be Appropriate ☢☢☢☢
MRA abdomen and pelvis without IV contrast May Be Appropriate O
US abdomen and pelvis with IV contrast May Be Appropriate O
US aorta abdomen with IV contrast May Be Appropriate O
US duplex Doppler aorta abdomen May Be Appropriate O
US abdomen and pelvis Usually Not Appropriate O
Aortography abdomen Usually Not Appropriate ☢☢☢
Aortography abdomen and pelvis Usually Not Appropriate ☢☢☢☢
Radiography abdomen and pelvis Usually Not Appropriate ☢☢☢

Panel Members
Daniel P. Sheeran, MDa, Ricky T. Tong, MD, PhDb, Minhaj S. Khaja, MD, MBAc, Mikhail C.S.S. Higgins, MD, MPHd, Nima Kokabi, MDe, Resmi Charalel, MD, MPHf, Aaron W. Aday, MD, MScg, Murthy R. Chamarthy, MDh, Benjamin N. Contrella, MDi, Anahita Dua, MBBChj, Sanjeeva P. Kalva, MDk, Nicole A. Keefe, MDl, Michael Malinowski, MDm, David S. Wang, MDn, Madison Wulfeck, MD, MBAo, Nicholas Fidelman, MDp, Bill S. Majdalany, MDq
Summary of Literature Review
Introduction/Background
Special Imaging Considerations
Discussion of Procedures by Variant
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
A. Aortography abdomen
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
B. Aortography abdomen and pelvis
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
C. CT abdomen and pelvis with IV contrast
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
D. CT abdomen and pelvis without and with IV contrast
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
E. CT abdomen and pelvis without IV contrast
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
F. CT abdomen and pelvis without IV contrast and US aorta abdomen with duplex Doppler
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
G. CTA abdomen and pelvis with IV contrast
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
H. CTA abdomen and pelvis without and with IV contrast
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
I. MRA abdomen and pelvis without and with IV contrast
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
J. MRA abdomen and pelvis without IV contrast
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
K. Radiography abdomen and pelvis
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
L. US abdomen and pelvis
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
M. US abdomen and pelvis with IV contrast
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
N. US aorta abdomen with IV contrast
Variant 1:Adult. Known abdominal aortic aneurysm or dissection without repair. Without or with new symptoms. Follow-up imaging.
O. US duplex Doppler aorta abdomen
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
A. Aortography abdomen
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
B. Aortography abdomen and pelvis
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
C. CT abdomen and pelvis with IV contrast
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
D. CT abdomen and pelvis without and with IV contrast
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
E. CT abdomen and pelvis without IV contrast
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
F. CT abdomen and pelvis without IV contrast and US aorta abdomen with duplex Doppler
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
G. CTA abdomen and pelvis with IV contrast
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
H. CTA abdomen and pelvis without and with IV contrast
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
I. MRA abdomen and pelvis without and with IV contrast
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
J. MRA abdomen and pelvis without IV contrast
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
K. Radiography abdomen and pelvis
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
L. US abdomen and pelvis
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
M. US abdomen and pelvis with IV contrast
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
N. US aorta abdomen with IV contrast
Variant 2:Adult. Endovascular aneurysm repair (EVAR) or open repair of abdominal aortic aneurysm or dissection. Preprocedure planning.
O. US duplex Doppler aorta abdomen
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
A. Aortography abdomen
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
B. Aortography abdomen and pelvis
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
C. CT abdomen and pelvis with IV contrast
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
D. CT abdomen and pelvis without and with IV contrast
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
E. CT abdomen and pelvis without IV contrast
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
F. CT abdomen and pelvis without IV contrast and US aorta abdomen with duplex Doppler
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
G. CTA abdomen and pelvis with IV contrast
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
H. CTA abdomen and pelvis without and with IV contrast
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
I. MRA abdomen and pelvis without and with IV contrast
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
J. MRA abdomen and pelvis without IV contrast
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
K. Radiography abdomen and pelvis
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
L. US abdomen and pelvis
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
M. US abdomen and pelvis with IV contrast
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
N. US aorta abdomen with IV contrast
Variant 3:Adult. After endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm or dissection. Follow-up imaging.
O. US duplex Doppler aorta abdomen
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
A. Aortography abdomen
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
B. Aortography abdomen and pelvis
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
C. CT abdomen and pelvis with IV contrast
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
D. CT abdomen and pelvis without and with IV contrast
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
E. CT abdomen and pelvis without IV contrast
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
F. CT abdomen and pelvis without IV contrast and US aorta abdomen with duplex Doppler
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
G. CTA abdomen and pelvis with IV contrast
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
H. CTA abdomen and pelvis without and with IV contrast
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
I. MRA abdomen and pelvis without and with IV contrast
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
J. MRA abdomen and pelvis without IV contrast
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
K. Radiography abdomen and pelvis
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
L. US abdomen and pelvis
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
M. US abdomen and pelvis with IV contrast
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
N. US aorta abdomen with IV contrast
Variant 4:Adult. After open repair of abdominal aortic aneurysm or dissection. Follow-up imaging.
O. US duplex Doppler aorta abdomen
Summary of Highlights
Supporting Documents

The evidence table, literature search, and appendix for this topic are available at https://acsearch.acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation.

For additional information on the Appropriateness Criteria methodology and other supporting documents, please go to the ACR website at https://www.acr.org/Clinical-Resources/Clinical-Tools-and-Reference/Appropriateness-Criteria.

Gender Equality and Inclusivity Clause

The ACR acknowledges the limitations in applying inclusive language when citing research studies that predates the use of the current understanding of language inclusive of diversity in sex, intersex, gender, and gender-diverse people. The data variables regarding sex and gender used in the cited literature will not be changed. However, this guideline will use the terminology and definitions as proposed by the National Institutes of Health.

Appropriateness Category Names and Definitions

Appropriateness Category Name

Appropriateness Rating

Appropriateness Category Definition

Usually Appropriate

7, 8, or 9

The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.

May Be Appropriate

4, 5, or 6

The imaging procedure or treatment may be indicated in the specified clinical scenarios as an alternative to imaging procedures or treatments with a more favorable risk-benefit ratio, or the risk-benefit ratio for patients is equivocal.

May Be Appropriate (Disagreement)

5

The individual ratings are too dispersed from the panel median. The different label provides transparency regarding the panel’s recommendation. “May be appropriate” is the rating category and a rating of 5 is assigned.

Usually Not Appropriate

1, 2, or 3

The imaging procedure or treatment is unlikely to be indicated in the specified clinical scenarios, or the risk-benefit ratio for patients is likely to be unfavorable.
Relative Radiation Level Information

Potential adverse health effects associated with radiation exposure are an important factor to consider when selecting the appropriate imaging procedure. Because there is a wide range of radiation exposures associated with different diagnostic procedures, a relative radiation level (RRL) indication has been included for each imaging examination. The RRLs are based on effective dose, which is a radiation dose quantity that is used to estimate population total radiation risk associated with an imaging procedure. Patients in the pediatric age group are at inherently higher risk from exposure, because of both organ sensitivity and longer life expectancy (relevant to the long latency that appears to accompany radiation exposure). For these reasons, the RRL dose estimate ranges for pediatric examinations are lower as compared with those specified for adults (see Table below). Additional information regarding radiation dose assessment for imaging examinations can be found in the ACR Appropriateness Criteria® Radiation Dose Assessment Introduction document.

Relative Radiation Level Designations

Relative Radiation Level*

Adult Effective Dose Estimate Range

Pediatric Effective Dose Estimate Range

O

0 mSv

 0 mSv

☢

<0.1 mSv

<0.03 mSv

☢☢

0.1-1 mSv

0.03-0.3 mSv

☢☢☢

1-10 mSv

0.3-3 mSv

☢☢☢☢

10-30 mSv

3-10 mSv

☢☢☢☢☢

30-100 mSv

10-30 mSv

*RRL assignments for some of the examinations cannot be made, because the actual patient doses in these procedures vary as a function of a number of factors (e.g., region of the body exposed to ionizing radiation, the imaging guidance that is used). The RRLs for these examinations are designated as “Varies.”
References
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Disclaimer
The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient’s clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient’s condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in an individual examination.