Management of Visceral Aneurysms
Publication Date: March 19, 2020
Last Updated: March 14, 2022
RECOMMENDATIONS
Renal artery aneurysm
In patients who are thought to have RAAs, we recommend computed tomography angiography (CTA) as the diagnostic tool of choice. (1 – Strong, B)
679
In patients who are thought to have RAA and have increased radiation exposure risks or renal insufficiency, we recommend non-contrast-enhanced magnetic resonance angiography (MRA) to establish the diagnosis. (1 – Strong, C)
Technical remark: Non-contrast-enhanced MRA is best suited to children and women of childbearing potential or those who have contraindications to CTA or MRA contrast materials (ie, pregnancy, renal insufficiency, or gadolinium contrast material allergy).
679
In patients with noncomplicated RAA of acceptable operative risk, we suggest treatment for aneurysm size >3 cm. (2 – Weak, C)
679
We recommend emergent intervention for any size RAA resulting in patient symptoms or rupture. (1 – Strong, B)
679
In patients of childbearing potential with noncomplicated RAA of acceptable operative risk, we suggest treatment regardless of size. (2 – Weak, B)
679
In patients with medically refractory hypertension and functionally important renal artery stenosis, we suggest treatment regardless of size. (2 – Weak, C)
679
We suggest daily antiplatelet therapy (ie, aspirin, 81 mg) for patients with RAA. (2 – Weak, C)
679
We suggest daily antiplatelet therapy (ie, aspirin, 81 mg) for patients with RAA. (2 – Weak, B)
679
We suggest ex vivo repair and autotransplantation for complex distal branch aneurysms over nephrectomy when it is technically feasible. (2 – Weak, B)
679
We suggest endovascular techniques for the elective repair of anatomically appropriate RAAs to include stent graft exclusion of main RAAs in patients with poor operative risk and embolization of distal and parenchymal aneurysms. (2 – Weak, B)
679
We suggest consideration of laparoscopic and robotic techniques as an interventional alternative based on institutional resources and surgeon experience with minimally invasive techniques. (2 – Weak, C)
679
We suggest screening female patients of childbearing age with RAA for fibromuscular dysplasia with a focused history and one-time axial imaging study (ie, CTA or MRA) to assess for cerebrovascular, mesenteric, and iliac artery dysplasia. (2 – Weak, C)
679
We suggest completion imaging after open surgical reconstruction for RAA, before hospital discharge, by way of axial imaging with CTA or MRA or arteriography in select cases, and long-term follow-up with surveillance imaging. (2 – Weak, C)
679
For patients managed nonoperatively, we suggest annual surveillance imaging until two consecutive studies are stable; thereafter, surveillance imaging may be extended to every 2 to 3 years. (2 – Weak, B)
679
Overview
Title
Management of Visceral Aneurysms
Authoring Organization
Society for Vascular Surgery