Management of Visceral Aneurysms
Key Points
Key Points
- These evidence-based practice guidelines offer recommendations to inform the diagnosis, treatment options, screening, and follow up of visceral aneurysms. The ultimate treatment goal should be to prevent aneurysm expansion and potential rupture by exclusion from the arterial circulation while maintaining necessary distal or collateral bed perfusion.
SVS Clinical Practice Guidelines on the Management of Visceral Aneurysms
Recommendations
...commendation...
Renal Artery Aneurysm (R...
...Diagnosis and evaluati...
...ts who are thought to have RAA, we...
....2 In patients who are thought to have RAA...
1.3 If preoperative planning and reco...
.... Size criteria and alternative indic...
...ients with noncomplicated RAA of a...
....2 We recommend emergent intervention...
...In patients of childbearing potenti...
...n patients with medically refractory hypertension...
.... Treatment optio...
...We suggest daily antiplatelet therapy (ie, low-dos...
....2 We suggest open surgical reconstruct...
...ggest ex vivo repair and autotransplantation...
...endovascular techniques for the elect...
...gest consideration of laparoscopic and robotic...
...Additional screening...
...t screening female patients with RA...
...llow-up and surveilla...
...completion imaging after open surgical recon...
...r patients managed nonoperatively, we suggest an...
...enic Artery Aneurysm (SAA)
...agnosis and evaluation...
...recommend CTA as the initial diagnostic...
...patients with suspected SAAs and pre-exist...
...ommend using arteriography when noninv...
...ications, size criteria, and true vs. fal...
...We recommend emergent intervention for r...
...mmend treatment of nonruptured splenic a...
....3 We recommend treating nonruptured splenic arter...
...d treating nonruptured splenic artery true an...
...uggest observation over repair for small (...
...Treatment options
...In patients with ruptured SAA discovere...
...nts with ruptured SAA diagnosed on preope...
...We suggest elective treatment of SAA us...
...t of SAA, we suggest that the splenic artery does...
...n treatment of distal SAA adjacent to th...
...t women with SAA, treatment decisions...
.... Screening...
....1 We suggest screening of patient...
...illance and follow-up
...tients in whom an SAA is being observed with a n...
...endovascular intervention for SAAs, we suggest p...
...ac Artery Aneurysm (CAA)
...gnosis and evaluation...
...ggest CTA as the initial diagnostic tool of choic...
1.2 We suggest MRA in patients with suspected C...
...We suggest arteriography when noninvasive studie...
...indications, size criteria, and true vs....
...We recommend emergent intervention for ruptu...
...2 We recommend treatment of nonruptured...
...nd treatment of nonruptured celiac artery t...
...observation over intervention for small (...
...Treatment options
3.1 In patients with ruptured CAA d...
...nts with ruptured CAA diagnosed on preoper...
...ctive treatment of CAA, we suggest using an endov...
...rmine the need for revascularization of...
.... Screen...
....1 We suggest screening patients wi...
...low-up and surveillanc...
...nts in whom a CAA is being observed with a no...
...er endovascular intervention for CAAs, we sug...
...stroepiploic Artery Aneurysms...
...Diagnosis and evaluat...
...atients who are thought to have gastric or gast...
1.2 In patients who are thought to ha...
...the use of catheter-based angiograph...
electively for preoperative planning. ( 1 –...
...Size criteria for invasive in...
...We recommend treatment of all gastric arter...
...atment options...
3.1 We recommend endovascular embol...
...ening for concomitant aneurysms...
4.1 We recommend abdominal axial imagi...
...mend one-time screening CTA (or MRA)...
...ow-up and surveillance...
5.1 We suggest interval surveillance (ie, every...
...We suggest postembolization surveillance every 1â...
...atic Artery Aneurysm...
.... Diagnosis and eval...
...ents who are thought to have HAA, we recom...
...with HAA who are considered for intervention, w...
...e criteria for invasive inte...
....1 Given the high propensity of rupture and...
...recommend repair of all symptomatic H...
...pair if true HAA is >2 cm or ( 1 –...
...rges >0.5 cm/y ( 1 – Strong , C)679...
...h significant comorbidities we recommend open...
...repair of HAA in patients with vascu...
...mmend repair in HAA patients with positive blood c...
3. Treatment optio...
...ommend an endovascular-first approach to...
...atients with extrahepatic aneurysms...
...In patients with intrahepatic aneurysms, we reco...
...eening for concomitant aneurysm and vascu...
...st abdominal axial imaging to screen for...
...suggest one-time screening CTA or MRA o...
...w-up and surveillance...
...nnual follow-up with CTA or non-contrast-enha...
...esenteric Artery Aneurysm (SMAA)...
...osis and evaluation...
...ts with SMAA, we recommend CTA as the d...
...We recommend mesenteric angiography to...
2. Size criteria for invasive intervention (true a...
...e recommend repair of all SMAAs and pseudoa...
....2 We suggest careful observation...
...Treatment options
...end an endovascular-first approach to al...
4. Screening for concomitant...
....1 We suggest abdominal axial imaging to screen fo...
...ollow-up and surveillance
...1 We suggest annual CTA to observe postsurg...
...al, and Colic Artery Aneurysm...
...nosis and evaluation...
...patients who are thought to have jejun...
...s with high radiation exposure risks or rena...
...emergent cases presenting with rupture...
...ively for preoperative planning. ( 1 – St...
....4 We suggest screening all patients wi...
...ria for invasive intervention (true...
...1 We recommend elective intervention for jejunal a...
...commend emergent intervention for any jejunal,...
...atment options...
...open surgical ligation or aneurysm excision for ca...
...endovascular embolization for case...
....3 We suggest medical treatment of nonruptured,...
.... Screening for concomitant aneur...
...abdominal axial imaging to screen for co...
...ne-time screening CTA (or MRA) of the...
5. Follow-up and survei...
...est interval surveillance (ie, every 12–24 mont...
...ostembolization surveillance every 1–2 yea...
Gastroduodenal Artery Aneurysm (GDAA)...
...agnosis and evaluation...
...In patients who are thought to have GDAA and...
...in whom celiac stenosis is suspected, we...
...In patients with high radiation expos...
.... Size criteria for invasive interv...
...ents with noncomplicated GDAA and PDAA of...
...Treatment options...
...s with intact and ruptured aneurysms, we r...
3.2 In patients in whom coil emboliza...
...tients with appropriate anatomy, we suggest tra...
...patients with suitable anatomy, we sug...
....5 In patients with nonruptured aneury...
...ts with concomitant stenosis or occlu...
...novo screening and screening for concomitan...
...ts with median arcuate ligament syndrome,...
...ollow-up and surveillance...
...ts status post treatment of GDAA and...
...Summary of Treatment Recommendations f...