Three-Dimensional Imaging in Vascular Surgery

Abstract

Managing complex aortic disease is one of the major challenges facing vascular surgery. With the advent of endovascular technology over the last two decades, there has been a rapid adoption of minimally invasive techniques allowing for the treatment of more complex disease. For many aortic disorders, the endovascular approach has replaced open surgery. This increases the preoperative imaging demands as accurate preoperative imaging, intraoperative assistance, and stringent postoperative surveillance have all become imperative. In diagnosing and planning management of aortic disease, digital subtraction angiography, which was once considered to be the gold standard, has been replaced by noninvasive imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI). Although there are other noninvasive imaging techniques, such as duplex ultrasonography and echocardiography, images thus acquired do not provide an anatomic overview and the possibility of treatment planning. Additionally, the information collected is often operator dependent. CT and MRI allow imaging of the entire aorta and its branches in high resolution, as well as extraluminal structures that may impact care. Images are readily presented as two-dimensional tomographic images; however, analysis and treatment planning using these images can be time consuming and tedious. Thus, three-dimensional reformatting and visualization have evolved, enabling presentation of the vasculature in a more convenient and intuitive way. This review explores the role of CT and MRI in everyday clinical practice. This review contains 18 figures, 4 tables, and 26 references.