Recommendations
12
Jejunal, Ileal, and Colic Artery Aneurysms
Recommendation
Grade/
LOE
1. Diagnosis and evaluation
1.1 In patients who are thought to have jejunal artery, ileal artery, and colic
artery aneurysms, we recommend CTA as the diagnostic tool of choice.
1-B
1.2 In patients with high radiation exposure risks or renal insufficiency, we
recommend non-contrast-enhanced MRA for diagnosis.
Technical remark: Non-contrast-enhanced MRA is best suited to children
and women of childbearing potential or those who have contraindications
to CTA or MRA contrast materials (ie, pregnancy, renal insufficiency, or
gadolinium contrast material allerg y).
1-C
1.3 We recommend the use of catheter-based angiography for all emergent
cases presenting with rupture (Grade 1B) and electively for preoperative
planning (Grade 1C).
1-B
1-C
1.4 We suggest screening all patients with jejunal, ileal, and colic artery
aneurysms for vasculitis with routine inflammatory markers.
2-C
2. Size criteria for invasive intervention (true aneurysms vs pseudoaneurysms)
2.1 We recommend elective intervention for jejunal and ileal artery
aneurysms >2 cm in maximal diameter and for all colic artery
aneurysms, any size.
1-B
2.2 We recommend emergent intervention for any jejunal, ileal, or colic
artery aneurysm, any size, resulting in patient symptoms or rupture and
all mesenteric branch vessel pseudoaneurysms.
1-A
3. Treatment options
3.1 We suggest open surgical ligation or aneurysm excision for cases of
jejunal, ileal, and colic artery aneurysms when laparotomy is being
considered for hematoma evacuation or bowel assessment for viability.
2-B
3.2 We suggest endovascular embolization for cases of jejunal, ileal, and
colic artery aneurysm.
2-B
3.3 We suggest medical treatment of nonruptured, asymptomatic ileal,
jejunal, and colic artery aneurysms associated with polyarteritis nodosa.
2-B
4. Screening for concomitant aneurysms
4.1 We suggest abdominal axial imaging to screen for concomitant
abdominal aneurysms.
2-B
4.2 We suggest one-time screening CTA (or MRA) of the head, neck, and
chest for those patients with segmental arterial mediolysis.
2-B
