Management of Visceral Aneurysms

Publication Date: March 19, 2020

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

...Recommendat...

...Renal Artery Ane...

...1. Diag...

...patients who are thought to have RAA, we recommend...

...ents who are thought to have RAA and have...

...eoperative planning and recognition of distal r...

...2. Size cri...

...ents with noncomplicated RAA of accept...

...end emergent intervention for any...

...In patients of childbearing potenti...

...n patients with medically refractory hyper...

...3. Treatme...

3.1 We suggest daily antiplatelet therap...

3.2 We suggest open surgical reconstruct...

...We suggest ex vivo repair and autotransplanta...

...uggest endovascular techniques for t...

...uggest consideration of laparoscopic and robotic...

...4. Ad...

...We suggest screening female patients with RA...

...5. Fo...

...st completion imaging after open sur...

...atients managed nonoperatively, we sugge...


...S...

1. Diagnosis...

...ecommend CTA as the initial diagnostic...

...2 In patients with suspected SAAs and pre...

...end using arteriography when noninvasive stud...

...2. Treatmen...

2.1 We recommend emergent intervention for ruptur...

...commend treatment of nonruptured splenic artery...

...ommend treating nonruptured splenic a...

...e recommend treating nonruptured splenic ar...

2.5 We suggest observation over repai...

...3. Treatment o...

...atients with ruptured SAA discovered at laparo...

...tients with ruptured SAA diagnosed on preoperati...

...lective treatment of SAA using an endovascu...

...atment of SAA, we suggest that the splenic a...

...reatment of distal SAA adjacent to the hilum of...

....6 In pregnant women with SAA, treatment decis...

...4. Screening...

...1 We suggest screening of patients wi...

...5. Surveillance and...

...In patients in whom an SAA is being observed...

...ovascular intervention for SAAs, we suggest peri...


...Celiac Arte...

...1. Diagnos...

1.1 We suggest CTA as the initial...

...est MRA in patients with suspected CAA and pr...

...We suggest arteriography when noninva...

...2...

...mend emergent intervention for rupture...

...ecommend treatment of nonruptured celiac...

...nd treatment of nonruptured celiac arte...

...est observation over intervention for sma...

...3. Treatment options...

...with ruptured CAA discovered at laparotomy, we su...

3.2 In patients with ruptured CAA...

...elective treatment of CAA, we sugges...

...To determine the need for revascula...

4...

...creening patients with CAAs for other arteri...

...5. Follow-up and sur...

...in whom a CAA is being observed with a...

...er endovascular intervention for CAA...


...Gas...

...1. Diagnos...

...n patients who are thought to have gastri...

...atients who are thought to have gastric or ga...

...ommend the use of catheter-based angiog...

...vely for preoperative planning. ( 1...

...2....

...treatment of all gastric artery and...

...3. Treatment options...

...ecommend endovascular embolization fo...

...4. Screening for con...

...d abdominal axial imaging to screen for c...

4.2 We recommend one-time screening CTA (or MRA)...

...5. Foll...

...interval surveillance (ie, every 12–24 m...

...e suggest postembolization surveillance e...


...Hepatic Artery A...

...1. Di...

...ents who are thought to have HAA, we...

...atients with HAA who are considered...

...2. Size crit...

...igh propensity of rupture and signif...

...a We recommend repair of all symptomat...

...mmend repair if true HAA is >2 cm or ( 1 ...

if aneurysm enlarges >0.5 cm/y ( 1...

...n patients with significant comorbidities...

...commend repair of HAA in patients w...

...nd repair in HAA patients with positive blood cu...

...3. Treatment...

...recommend an endovascular-first approach to...

...In patients with extrahepatic aneurysms, we recom...

...atients with intrahepatic aneurysms, we recommend...

...4. Screening...

...suggest abdominal axial imaging to scre...

....2 We suggest one-time screening C...

...suggest annual follow-up with CTA or non...


...Superior Mesent...

...1. Diagnos...

...with SMAA, we recommend CTA as the...

...2 We recommend mesenteric angiography to deline...

...2. Size cri...

...mmend repair of all SMAAs and pseudoane...

...We suggest careful observation of SMAA because of...

...3. Treatment optio...

...1 We recommend an endovascular-first approach to a...

...4. Scr...

...bdominal axial imaging to screen f...

...5. Follow-up and surv...

...t annual CTA to observe postsurgical...


...Jejunal, Ile...

...1. Dia...

...1 In patients who are thought to h...

...with high radiation exposure risks or re...

...emergent cases presenting with rupture and...

...preoperative planning. ( 1 – Strong...

...suggest screening all patients with jejunal, ile...

...2. Size cri...

...nd elective intervention for jejunal a...

...ecommend emergent intervention for any jejun...

...3. Treat...

...t open surgical ligation or aneurysm excisio...

...endovascular embolization for cases of j...

...suggest medical treatment of nonruptured, a...

...4. S...

...1 We suggest abdominal axial imaging to screen for...

...suggest one-time screening CTA (or MRA) of the hea...

...est interval surveillance (ie, every...

...e suggest postembolization surveillance every 1...


...Gastroduodenal Ar...

...1. Diagnosis...

1.1 In patients who are thought to...

...ients in whom celiac stenosis is su...

....3 In patients with high radiation exposure...

...2. Size c...

...patients with noncomplicated GDAA a...

...3. Treatment option...

...atients with intact and ruptured aneurysms, we rec...

3.2 In patients in whom coil embolization is not f...

...n patients with appropriate anatom...

...with suitable anatomy, we suggest flow-divert...

...ts with nonruptured aneurysms, we suggest open s...

...6 In patients with concomitant stenosis or occlu...

...4. De novo...

...patients with median arcuate ligament syndro...

...5. Follow-up and su...

...nts status post treatment of GDAA and PDAA, we...


...ummary of Treatment Recommendations for Extr...