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
...ommendations...
...tery Aneurysm (RAA)...
...iagnosis and evaluati...
...In patients who are thought to have...
...ents who are thought to have RAA and have increa...
...tive planning and recognition of distal renal arte...
...ria and alternative indications for...
....1 In patients with noncomplicated RAA of accepta...
...We recommend emergent intervention for...
...tients of childbearing potential w...
2.4 In patients with medically refractory h...
.... Treatment options...
3.1 We suggest daily antiplatelet therapy...
...uggest open surgical reconstructive...
...suggest ex vivo repair and autotransp...
...suggest endovascular techniques for the e...
...consideration of laparoscopic and robotic...
...itional screenin...
...uggest screening female patients with RAA f...
...Follow-up and surveil...
...e suggest completion imaging after open surgical...
....2 For patients managed nonoperatively, we sugg...
...Artery Aneurysm (SAA)...
...nosis and evaluation...
1.1 We recommend CTA as the initial diagnos...
...tients with suspected SAAs and pre-existing re...
...mmend using arteriography when noninvasive stud...
...tment indications, size criteria, and true vs. f...
...1 We recommend emergent intervention for...
....2 We recommend treatment of nonruptured s...
...d treating nonruptured splenic artery true...
...treating nonruptured splenic artery true an...
...uggest observation over repair for small (...
...Treatment options...
...patients with ruptured SAA discov...
....2 In patients with ruptured SAA diagnosed on...
...est elective treatment of SAA using an endovascul...
...In treatment of SAA, we suggest that the splen...
...of distal SAA adjacent to the hilum of t...
...women with SAA, treatment decisions should be i...
...Screenin...
....1 We suggest screening of patients with...
...eillance and follow-up...
...s in whom an SAA is being observed wi...
...scular intervention for SAAs, we sug...
...Artery Aneurysm (C...
...agnosis and evaluati...
...gest CTA as the initial diagnostic tool of cho...
...We suggest MRA in patients with sus...
...t arteriography when noninvasive studi...
...reatment indications, size criteria, and true ...
...ecommend emergent intervention for rup...
...end treatment of nonruptured celiac artery...
...treatment of nonruptured celiac artery true ane...
...est observation over intervention for small (...
...Treatment options...
...ts with ruptured CAA discovered at l...
...s with ruptured CAA diagnosed on preoper...
...the elective treatment of CAA, we suggest...
...determine the need for revascularization of...
4. Screen...
...creening patients with CAAs for other art...
...Follow-up and surveillanc...
...nts in whom a CAA is being observed with a no...
...fter endovascular intervention for CA...
...Gastroepiploic Artery Aneurysms...
...gnosis and evaluat...
...who are thought to have gastric or gastroepiploic...
...who are thought to have gastric or...
...the use of catheter-based angiograph...
...reoperative planning. ( 1 – Strong...
...riteria for invasive interventi...
....1 We recommend treatment of all gastric artery an...
3. Treatment op...
...e recommend endovascular embolization...
...eening for concomitant aneurysms...
4.1 We recommend abdominal axial ima...
...nd one-time screening CTA (or MRA) of the...
...Follow-up and surveill...
...interval surveillance (ie, every 1...
...t postembolization surveillance every 1–2 ye...
...c Artery Aneurysm (H...
...agnosis and evaluat...
....1 In patients who are thought to ha...
....2 In patients with HAA who are considere...
...ze criteria for invasive intervent...
...igh propensity of rupture and significant...
...commend repair of all symptomatic HAAs...
...recommend repair if true HAA is >...
if aneurysm enlarges >0.5 cm/y ( 1 – Strong...
...ts with significant comorbidities we recommend...
2.3 We recommend repair of HAA in patients with...
...nd repair in HAA patients with positive blood cult...
...reatment options
...mmend an endovascular-first approach to all HAA...
...n patients with extrahepatic aneurysm...
...tients with intrahepatic aneurysms, we...
...or concomitant aneurysm and vascular disea...
4.1 We suggest abdominal axial imagi...
....2 We suggest one-time screening CTA or...
5. Follow-up and sur...
...e suggest annual follow-up with CTA or...
...senteric Artery Aneurysm (SMA...
...gnosis and evaluation...
...ts with SMAA, we recommend CTA as the dia...
...We recommend mesenteric angiograp...
...ia for invasive intervention (true and fa...
...d repair of all SMAAs and pseudoaneurysms as s...
...We suggest careful observation of SMAA because...
...eatment options
...1 We recommend an endovascular-first approach...
...ening for concomitant aneury...
...gest abdominal axial imaging to screen for co...
...w-up and surveillance...
5.1 We suggest annual CTA to observe po...
...nal, Ileal, and Colic Artery Aneurysms...
...iagnosis and evaluation...
...1 In patients who are thought to have je...
....2 In patients with high radiation exposure ri...
...or all emergent cases presenting with rupture an...
...vely for preoperative planning. ( 1 – Strong...
...ggest screening all patients with j...
...ria for invasive intervention (true aneurysms v...
...elective intervention for jejunal and i...
...We recommend emergent intervention for any jeju...
...Treatment options...
...1 We suggest open surgical ligation or aneurysm ex...
...t endovascular embolization for cases of jejuna...
...est medical treatment of nonruptured, asym...
...ng for concomitant aneurysms...
...1 We suggest abdominal axial imagi...
...suggest one-time screening CTA (or MR...
...Follow-up and surve...
...We suggest interval surveillance (ie, every 12–...
...2 We suggest postembolization surveillance eve...
...troduodenal Artery Aneurysm (GDAA) and Pancreati...
...iagnosis and evaluati...
...In patients who are thought to have GDAA and...
...In patients in whom celiac stenosis is suspected,...
...tients with high radiation exposure risks...
2. Size criteria for invasive i...
...n patients with noncomplicated GDAA an...
3. Treatment o...
...patients with intact and ruptured aneurys...
...nts in whom coil embolization is not feasible,...
...patients with appropriate anatomy, we suggest t...
...In patients with suitable anatomy, we suggest fl...
...nts with nonruptured aneurysms, we suggest...
...nts with concomitant stenosis or occlusion, we su...
...creening and screening for concomitant aneurysms...
....1 In patients with median arcuate ligament sy...
...Follow-up and surveil...
...n patients status post treatment of GDAA an...
...ummary of Treatment Recommendations for Extrahep...