Introduction
Abdominal Aortic Aneurysms (AAA) represent a severe cardiovascular threat due to the high mortality associated with acute rupture. Endovascular Aortic Repair (EVAR) has transformed aneurysm management, offering a minimally invasive alternative to open abdominal surgery. However, EVAR durability depends heavily on strict anatomical suitability regarding proximal aortic neck length, angulation, calcification, and iliac artery access diameters.
Deploying algorithmic computer vision models to evaluate Computed Tomography Angiography (CTA) scans allows vascular surgeons to rapidly measure aneurysm dimensions, identify thrombus burden, and flag adverse anatomical features during preliminary clinical triage.
CTA Feature Detection & Anatomical Parameter Mapping
Advanced AI segmentation models process thin-slice CTA DICOM datasets to build automated 3D centerline reconstructions of the aorta and iliac vessels. Key anatomical parameters measured by the algorithm include:
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Maximum Transverse Aneurysm Diameter: Automated outer-to-outer wall lumen measurement perpendicular to the aortic blood flow centerline.
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Proximal Aortic Neck Geometry: Calculating neck length ($>10\text{–}15\text{ mm}$ required for standard IFU stent-grafts) and infrarenal neck angulation ($<60^\circ$).
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Access Vessel Diameters & Tortuosity: Evaluating iliac artery lumen width ($>6\text{ mm}$) and luminal calcification to prevent access vessel rupture during delivery sheath insertion.
Vascular Triage Prompt Example:
“Analyze this abdominal CT angiography DICOM reconstruction for a suspected AAA. Measure the maximum aortic diameter, proximal infrarenal neck length and angulation, mural thrombus volume percentage, and bilateral common iliac lumen diameters.”
Workflow Efficiency & Diagnostic Sensitivity
| Evaluation Metric | Manual CTA Reconstruction | AI-Automated Centerline Mapping | Clinical Advantage |
| Average Measurement Time | 20–35 minutes per scan | <2 minutes | Rapid pre-procedure planning |
| Centerline Axis Accuracy | Variable (Risk of oblique measurement error) | Automatic orthogonal lumen slicing | Eliminates false diameter inflation |
| Thrombus Volume Calculation | Manual estimation / Time-intensive | Automated volumetric segmentation | Precise rupture risk tracking |
| IFU Compliance Screening | Manual checklist review | Automated stent-graft criteria match | Faster device selection decisions |
Safety, Governance & Clinical Decision Making
In vascular and endovascular surgery, automated analysis serves as an assistive anatomical mapping tool:
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Verification of Anatomical Neck Security: The operating vascular surgeon must manually double-check proximal neck seal zones on multiplanar reformatted (MPR) images prior to committing to an endograft device.
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Serial Expansion Monitoring: Automated volumetric tracking provides reliable comparison between sequential CT scans to detect subtle annual growth ($>5\text{ mm}$ per year) requiring surgical intervention.
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Human-in-the-Loop Standard: Device selection, access site management, and open conversion contingency plans remain under the direct governance of the surgical team.