13
Jejunal, Ileal, and Colic Artery Aneurysms
Recommendation
Grade/
LOE
5. Follow-up and surveillance
5.1 We suggest interval surveillance (ie, every 12–24 months) with axial
imaging (ie, CTA or MRA) for cases of segmental medial arteriolysis in
light of reported cases of rapid arterial transformation and to monitor
regression in cases of polyarteritis nodosa.
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-B
Gastroduodenal Artery Aneurysm (GDAA) and
Pancreaticoduodenal Artery Aneurysm (PDAA)
Recommendation
Grade/
LOE
1. Diagnosis and evaluation
1.1 In patients who are thought to have GDAA and PDAA, we recommend
CTA as the diagnostic tool of choice.
1-B
1.2 In patients in whom celiac stenosis is suspected, we suggest further
workup with duplex ultrasound to elucidate whether the stenosis is
hemodynamically significant.
2-C
1.3 In patients with high radiation exposure risks or renal insufficiency, we
suggest noncontrast-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).
2-C
2. Size criteria for invasive intervention
2.1 In patients with noncomplicated GDAA and PDAA of acceptable
operative risk, we recommend treatment no matter the size of the
aneurysm because of the risk of rupture.
1-B
3. Treatment options
3.1 In patients with intact and ruptured aneurysms, we recommend coil
embolization as the treatment of choice.
1-B
3.2 In patients in whom coil embolization is not feasible, we suggest
covered stenting or stent-assisted coil embolization as a treatment
option in select cases of GDAA and PDAA.
2-C
(cont'd)
