9
Gastric and Gastroepiploic Artery Aneurysms
Recommendation
Grade/
LOE
4. Screening for concomitant aneurysms
4.1 We recommend abdominal axial imaging to screen for concomitant
abdominal aneurysms.
2-B
4.2 We recommend one-time screening CTA (or MRA) of the head, neck,
and chest for those patients with segmental arterial mediolysis.
2-C
5. Follow-up and surveillance
5.1 We suggest interval surveillance (ie, every 12–24 months) with axial
imaging (ie, CTA or MRA) in cases of segmental medial arteriolysis in
light of reported cases of rapid arterial transformation.
2-B
5.2 We suggest postembolization surveillance every 1–2 years with axial
imaging to assess for vascular remodeling and evidence of aneurysm
reperfusion.
2-C
Hepatic Artery Aneurysm (HAA)
Recommendation
Grade/
LOE
1. Diagnosis and evaluation
1.1 In patients who are thought to have HAA, we recommend CTA as the
diagnostic tool of choice.
2-B
1.2 In patients with HAA who are considered for intervention, we
recommend mesenteric angiography for preoperative planning.
1-B
2. Size criteria for invasive intervention
2.1 Given the high propensity of rupture and significant antecedent
mortality, we recommend that all hepatic artery pseudoaneurysms,
regardless of cause, be repaired as soon as the diagnosis is made.
1-A
2.2.a We recommend repair of all symptomatic HAAs regardless of size. 1-A
2.2.b In asymptomatic patients without significant comorbidity, we
recommend repair if true HAA is >2 cm (Grade 1A) or if aneurysm
enlarges >0.5 cm/y (Grade 1C). In patients with significant
comorbidities, we recommend open repair if HAA is >5.0 cm (Grade
1B).
1-A
1-B
1-C
2.3 We recommend repair of HAA in patients with vasculopathy or
vasculitis, regardless of size (Grade 1C). We recommend repair in HAA
patients with positive blood cultures (Grade 1C).
1-C
(cont'd)
