ACR Appropriateness Criteria® Abdominal Aortic Aneurysm or Dissection-Interventional Planning and Follow-Up: Update 2025.

Abstract

Guidelines were developed for aortic evaluation based on a patient's health status, comorbidities, and the aneurysm's maximum diameter. The arrival of the endovascular aneurysm repair (EVAR) technique and its more advanced permutations introduced new variables to managing abdominal aortic aneurysm (AAA) and aortic dissection. For patients who present de novo for treatment of AAA or aortic dissection without any prior imaging available, the entire aorta (including the thoracic portion) should be assessed to fully characterize the anatomy. Preoperative imaging has one primary focus: to determine the need and feasibility for surgery based on anatomy, pathology extent, and rate of growth. Following both open and endovascular repair, surveillance imaging is needed. This is particularly true for EVAR due to its higher rate of complications that require reintervention. Successful therapy results in an aneurysm or dissection that remains stable or decreases in size with preserved branch vessel flow, as documented on surveillance imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.