The contrast enhanced computed tomography (CT) scan is currently the best overall study for the preoperative evaluation of abdominal aortic aneurysm architecture. Diameter measurements are accurate within 0.2 cm. CT is moderately accurate for detecting suprarenal involvement (83% sensitive, 90% specific, positive predictive value 48%). This study demonstrates the right renal artery (solid marks) coming off the aorta at a level of the aneurysm with mural thrombus (white arrow), making this aneurysm pararenal. The superior mesenteric artery (dotted arrow) can be seen in cross-section.
The proximal extent of the aneurysm on the CT scan mandates angiography (lateral view shown) to determine the appropriate area to place a suprarenal clamp (suprarenal vs. supraceliac). Here you see the superior mesenteric artery (arrow) and the celiac artery (dashed arrow).
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