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

...mendations...

Renal Artery Aneurysm...

...sis and evaluation...

...who are thought to have RAA, we recommen...

...patients who are thought to have RAA...

...erative planning and recognition o...

...Size criteria and alternative indicati...

...ts with noncomplicated RAA of acceptable...

...ommend emergent intervention for any size RAA resu...

...of childbearing potential with nonc...

...n patients with medically refracto...

...Treatment opt...

3.1 We suggest daily antiplatelet therapy (ie, l...

...est open surgical reconstructive techniques f...

...e suggest ex vivo repair and autotr...

...st endovascular techniques for the elect...

...We suggest consideration of laparoscopic and r...

...ditional screening...

...suggest screening female patients...

...ollow-up and surveilla...

...We suggest completion imaging after open su...

...tients managed nonoperatively, we...


...lenic Artery Aneurysm (SA...

...Diagnosis and evaluatio...

...We recommend CTA as the initial diagnostic tool o...

...nts with suspected SAAs and pre-ex...

...commend using arteriography when noni...

...indications, size criteria, and true vs. false...

...d emergent intervention for ruptured SAA...

...d treatment of nonruptured splenic...

...We recommend treating nonruptured splenic...

...We recommend treating nonruptured sp...

...observation over repair for small (...

3. Treatment opt...

...nts with ruptured SAA discovered at laparotom...

...atients with ruptured SAA diagnosed on pre...

...ggest elective treatment of SAA using...

...n treatment of SAA, we suggest that the splen...

...treatment of distal SAA adjacent to the h...

...t women with SAA, treatment decisions sh...

...creening

...suggest screening of patients with SAAs for o...

...Surveillance and follow-up...

...nts in whom an SAA is being observed with a n...

5.2 After endovascular intervention for...


...rtery Aneurysm (CAA)...

.... Diagnosis and evaluation...

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

...suggest MRA in patients with suspected CAA...

...suggest arteriography when noninvasive...

...eatment indications, size criteria, and true v...

...recommend emergent intervention for ruptured C...

...d treatment of nonruptured celiac artery pseudoan...

...nd treatment of nonruptured celiac ar...

...est observation over intervention for smal...

...Treatment options...

...ients with ruptured CAA discovered at laparotomy,...

...ients with ruptured CAA diagnosed on preoperati...

...tive treatment of CAA, we suggest usin...

...e the need for revascularization of the celiac a...

...creening...

....1 We suggest screening patients wit...

...-up and surveillance...

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

...endovascular intervention for CAAs, we suggest...


...astroepiploic Artery Aneurysms...

...osis and evaluation...

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

...patients who are thought to have gastric...

...recommend the use of catheter-based angiograph...

...r preoperative planning. ( 1 – Strong ,...

...ze criteria for invasive interventi...

...ommend treatment of all gastric arte...

3. Treatment o...

3.1 We recommend endovascular embolizat...

...for concomitant aneurysms...

...end abdominal axial imaging to screen for con...

4.2 We recommend one-time screening CTA (or M...

...Follow-up and surveillanc...

...est interval surveillance (ie, every 12–...

...t postembolization surveillance every 1–2...


...c Artery Aneurysm (HAA)...

...agnosis and evaluation...

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

...tients with HAA who are considered for int...

...criteria for invasive intervention...

...1 Given the high propensity of rup...

...commend repair of all symptomatic HA...

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

...enlarges >0.5 cm/y ( 1 – Strong , C)67...

...with significant comorbidities we recomme...

...recommend repair of HAA in patients with...

...commend repair in HAA patients with positive...

...Treatment options

...an endovascular-first approach to all HAA...

....2 In patients with extrahepatic aneurysms, we re...

...with intrahepatic aneurysms, we recommend coil...

...concomitant aneurysm and vascular dise...

...bdominal axial imaging to screen for concomitant...

...est one-time screening CTA or MRA of t...

...ollow-up and surveillance...

....1 We suggest annual follow-up with CT...


...ior Mesenteric Artery Aneurysm...

...nosis and evaluation...

...patients with SMAA, we recommend CTA as th...

....2 We recommend mesenteric angiography to delinea...

...Size criteria for invasive intervention...

...We recommend repair of all SMAAs and ps...

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

...Treatment option...

...commend an endovascular-first approach to all SMAA...

...eening for concomitant aneur...

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

...w-up and surveillance...

...1 We suggest annual CTA to observe postsurgic...


...Ileal, and Colic Artery Aneurysm...

...Diagnosis and evaluation...

...who are thought to have jejunal artery, ileal art...

...ents with high radiation exposure risks...

...t cases presenting with rupture and (...

...ively for preoperative planning. ( 1 – St...

...uggest screening all patients with jejunal, il...

...ria for invasive intervention (true aneurysms v...

...We recommend elective intervention for jej...

...recommend emergent intervention for any jejun...

...reatment options...

...uggest open surgical ligation or aneurysm ex...

...st endovascular embolization for cases of jej...

...edical treatment of nonruptured, a...

...Screening for concomitant aneurysms...

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

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

...low-up and surveillance...

5.1 We suggest interval surveillance...

...We suggest postembolization surveillance every...


...stroduodenal Artery Aneurysm (GDAA) and Pan...

...iagnosis and evaluation...

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

...tients in whom celiac stenosis is suspected,...

...nts with high radiation exposure ris...

...eria for invasive intervention...

...patients with noncomplicated GDAA...

3. Treatment optio...

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

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

...n patients with appropriate anatomy, we sugges...

3.4 In patients with suitable anatomy, we sug...

...with nonruptured aneurysms, we suggest...

...with concomitant stenosis or occlusion, we sug...

...ovo screening and screening for co...

...In patients with median arcuate li...

...Follow-up and surve...

...tients status post treatment of GDAA an...


...mary of Treatment Recommendations for Extrahepat...