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
...mmendation...
...Artery Aneurysm (RAA)...
...Diagnosis and eva...
...n patients who are thought to have RAA, we rec...
...ents who are thought to have RAA and ha...
...erative planning and recognition of...
...eria and alternative indications for interventi...
...patients with noncomplicated RAA of ac...
...commend emergent intervention for any size RAA re...
....3 In patients of childbearing potential wit...
...n patients with medically refractory...
3. Treatment options
....1 We suggest daily antiplatelet therapy (ie, low-...
....2 We suggest open surgical reconstruc...
...t ex vivo repair and autotransplantation for compl...
...endovascular techniques for the elec...
...gest consideration of laparoscopic and roboti...
...itional screenin...
....1 We suggest screening female patients...
...-up and surveillance...
...t completion imaging after open surgica...
...r patients managed nonoperatively, we...
Splenic Artery Aneurysm (SA...
...Diagnosis and evaluation
...recommend CTA as the initial diagnostic to...
...n patients with suspected SAAs and pre-existing r...
1.3 We recommend using arteriography when...
...indications, size criteria, and true v...
...mend emergent intervention for ruptured SAAs. (...
...recommend treatment of nonruptured splenic arter...
...mend treating nonruptured splenic ar...
...We recommend treating nonruptured splenic artery t...
...observation over repair for small (...
3. Treatment option...
...1 In patients with ruptured SAA discovered at...
...s with ruptured SAA diagnosed on preopera...
...ggest elective treatment of SAA using an e...
...In treatment of SAA, we suggest that the splenic...
...n treatment of distal SAA adjacent to the hilu...
...pregnant women with SAA, treatment...
.... Screeni...
...gest screening of patients with SAAs fo...
...illance and follow-up...
...ts in whom an SAA is being observed with a nonope...
5.2 After endovascular intervention...
...tery Aneurysm (CAA)
...osis and evaluation...
...uggest CTA as the initial diagnostic tool of c...
...suggest MRA in patients with suspected CAA and p...
...st arteriography when noninvasive studies have...
...ications, size criteria, and true vs. fal...
...ommend emergent intervention for ru...
...e recommend treatment of nonruptured cel...
...ecommend treatment of nonruptured celi...
...uggest observation over intervention...
.... Treatment opt...
3.1 In patients with ruptured CAA discovered at l...
...patients with ruptured CAA diagnosed on...
...the elective treatment of CAA, we sugge...
....4 To determine the need for revascularization of...
...creening...
...gest screening patients with CAAs f...
...low-up and surveillance...
...nts in whom a CAA is being observed with a non...
...2 After endovascular intervention f...
...Gastroepiploic Artery Aneurysms...
...osis and evaluation...
...ents who are thought to have gastric o...
...ts who are thought to have gastric or gastroepip...
...e use of catheter-based angiograph...
...preoperative planning. ( 1 – Strong , C)67...
2. Size criteria for invasive interventi...
...nd treatment of all gastric artery and gastroepip...
...eatment options...
...commend endovascular embolization...
...ng for concomitant aneurysms...
...ommend abdominal axial imaging to scre...
...ecommend one-time screening CTA (or MR...
...-up and surveillance...
...ggest interval surveillance (ie, every...
...e suggest postembolization surveillance...
...Artery Aneurysm (HAA)...
...nosis and evaluation...
...In patients who are thought to have HAA, we re...
...2 In patients with HAA who are considered for inte...
...iteria for invasive intervention...
...iven the high propensity of rupture and...
...recommend repair of all symptomati...
...recommend repair if true HAA is >2...
...rges >0.5 cm/y ( 1 – Strong , C)679...
...atients with significant comorbidities w...
...e recommend repair of HAA in patients w...
...e recommend repair in HAA patients with...
.... Treatment opt...
....1 We recommend an endovascular-first approach to...
...nts with extrahepatic aneurysms, we recommend o...
...In patients with intrahepatic aneury...
...n patients with large intrahepatic HAA, we re...
...r concomitant aneurysm and vascular disease...
...suggest abdominal axial imaging to screen for...
...gest one-time screening CTA or MRA of the head, n...
...ollow-up and surveillance...
...annual follow-up with CTA or non-con...
...or Mesenteric Artery Aneurysm (SMAA)...
...nosis and evaluation...
...In patients with SMAA, we recommend CTA as...
...We recommend mesenteric angiography t...
...eria for invasive intervention (true and...
2.1 We recommend repair of all SMAAs and pseudoane...
...gest careful observation of SMAA b...
...eatment options...
....1 We recommend an endovascular-first approach t...
...eening for concomitant aneury...
...st abdominal axial imaging to screen...
...Follow-up and survei...
...We suggest annual CTA to observe postsurgical...
...al, and Colic Artery Aneurysm...
...agnosis and evaluation...
...In patients who are thought to have jejunal art...
...n patients with high radiation expos...
...gent cases presenting with rupture...
...for preoperative planning. ( 1 – Strong , C)67...
...e suggest screening all patients wi...
...e criteria for invasive intervention (tr...
....1 We recommend elective intervention for...
...2 We recommend emergent interventio...
...eatment options...
...suggest open surgical ligation or aneurysm...
...gest endovascular embolization for cases of jeju...
...edical treatment of nonruptured, asymptomat...
...reening for concomitant aneurysms
...suggest abdominal axial imaging to scree...
...e suggest one-time screening CTA (or MRA) of the h...
...ollow-up and surveillance...
...t interval surveillance (ie, every 12–2...
5.2 We suggest postembolization surveil...
...denal Artery Aneurysm (GDAA) and P...
...sis and evaluation...
...atients who are thought to have GDAA and PDAA,...
...In patients in whom celiac stenosis is sus...
...n patients with high radiation exp...
...criteria for invasive intervention
...patients with noncomplicated GDAA and P...
.... Treatment option...
...nts with intact and ruptured aneurysms, we...
...s in whom coil embolization is not fea...
...s with appropriate anatomy, we sugg...
...n patients with suitable anatomy, we sugge...
...ients with nonruptured aneurysms, we suggest o...
...In patients with concomitant stenosis or...
...creening and screening for concomitant aneurysm...
...ts with median arcuate ligament synd...
5. Follow-up and surveillance
...patients status post treatment of GDAA...
...Summary of Treatment Recommendations for E...