SVS Guidelines Bundle

Visceral Aneurysms

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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

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