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

...Renal Artery Aneur...

...1. Diagnosis and...

...In patients who are thought to have RAA, we recom...

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

...ative planning and recognition of d...

...2. Size criter...

...patients with noncomplicated RAA of accepta...

...recommend emergent intervention for any size RAA...

...tients of childbearing potential w...

...n patients with medically refractory hyp...

...3. Treatment...

....1 We suggest daily antiplatelet thera...

...ggest open surgical reconstructive techniques fo...

...ex vivo repair and autotransplantation for...

...est endovascular techniques for the el...

...ggest consideration of laparoscopic and robotic t...

...4. Ad...

...uggest screening female patients wi...

...We suggest completion imaging after open surgic...

...For patients managed nonoperatively, we sugge...


...Splenic Ar...

...We recommend CTA as the initial diagnost...

...nts with suspected SAAs and pre-existing rena...

...d using arteriography when noninvasive stud...

...2. Treatment indica...

...mend emergent intervention for ruptured SAA...

2.2 We recommend treatment of nonruptured spleni...

...commend treating nonruptured splenic ar...

...4 We recommend treating nonruptured sp...

...We suggest observation over repair for small (...

...3. Treatment options...

...atients with ruptured SAA discovered at la...

....2 In patients with ruptured SAA d...

...We suggest elective treatment of SAA usi...

...4 In treatment of SAA, we suggest that the splen...

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

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

...4. Screening...

...st screening of patients with SAAs for other intr...

...5. Surveillance an...

...nts in whom an SAA is being observ...

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


...Celiac Artery Aneu...

...1. Diagnosis and e...

...suggest CTA as the initial diagnostic tool of c...

...gest MRA in patients with suspected CA...

...arteriography when noninvasive studies have not s...

...2. Treat...

2.1 We recommend emergent intervention...

...e recommend treatment of nonruptured ce...

...nd treatment of nonruptured celiac a...

...observation over intervention for small...

...3. Treatment o...

...In patients with ruptured CAA discovered a...

...In patients with ruptured CAA diagnosed on pre...

...he elective treatment of CAA, we suggest usin...

3.4 To determine the need for revascularizati...

...4. Screening

...We suggest screening patients with CAAs fo...

...5. Follo...

...ients in whom a CAA is being observe...

...ter endovascular intervention for CAAs, we sugges...


...Gastric and Gastroepiploic...

...1. Diagnosis and evalu...

...who are thought to have gastric or gastro...

...In patients who are thought to have g...

...ommend the use of catheter-based angiography for...

electively for preoperative planning...

...2. Siz...

2.1 We recommend treatment of all gastric a...

...3. Tre...

...mend endovascular embolization for first-line...

...4. Screeni...

4.1 We recommend abdominal axial imaging to...

...end one-time screening CTA (or MRA) of the he...

...5. F...

...suggest interval surveillance (ie, every 12...

...uggest postembolization surveillance e...


...Hepatic Art...

...1. Di...

...atients who are thought to have HAA, we reco...

...ts with HAA who are considered for intervention,...

...2. Size cri...

...Given the high propensity of rupture and significa...

...recommend repair of all symptomatic HAAs regardle...

...end repair if true HAA is >2 cm or ( 1 – Strong...

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

...patients with significant comorbid...

...repair of HAA in patients with vasc...

...recommend repair in HAA patients with po...

...3. Treatme...

...an endovascular-first approach to a...

...with extrahepatic aneurysms, we recommend...

...n patients with intrahepatic aneurysms, we reco...

...4. Screening for conc...

...uggest abdominal axial imaging to sc...

...est one-time screening CTA or MRA of the head, nec...

...5....

...nnual follow-up with CTA or non-contras...


...Superior Mesenteri...

...1. Diagnosis and...

....1 In patients with SMAA, we recommend CTA as...

...mmend mesenteric angiography to delineate...

...2. Si...

...end repair of all SMAAs and pseudoaneurysms as s...

...gest careful observation of SMAA becau...

...3. Treatment...

...d an endovascular-first approach to all SMAAs if i...

...4. Screen...

...e suggest abdominal axial imaging to scr...

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

...nnual CTA to observe postsurgical patients. ( 2 ...


...J...

1. Diag...

1.1 In patients who are thought to have j...

...atients with high radiation exposure risks or r...

...ent cases presenting with rupture and ( 1 – Str...

...ly for preoperative planning. ( 1 – Strong , C)...

....4 We suggest screening all patients w...

...2. Size criteria for...

...1 We recommend elective intervention for jejunal a...

...mend emergent intervention for any...

...3. Treat...

...pen surgical ligation or aneurysm excision...

...suggest endovascular embolization for cases...

3.3 We suggest medical treatment of nonruptured...

...We suggest abdominal axial imaging to scr...

...one-time screening CTA (or MRA) of...

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

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

...ostembolization surveillance every...


...Gastroduod...

...1. Diagnosis and...

...patients who are thought to have GDAA and P...

....2 In patients in whom celiac stenosis is suspect...

...atients with high radiation exposure risks...

...2. Size cri...

...tients with noncomplicated GDAA and PDAA of...

...3. Tre...

...patients with intact and ruptured aneur...

...in whom coil embolization is not feasible, w...

...patients with appropriate anatomy, we su...

...n patients with suitable anatomy, we sug...

...ts with nonruptured aneurysms, we sugges...

...ts with concomitant stenosis or occlusion,...

...4. De novo scre...

...with median arcuate ligament syndrome, we...

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

...n patients status post treatment of GDAA and PDAA,...


...ble 1. Summary of Treatment Recommendations for...