7
Celiac Artery Aneurysm (CAA)
Recommendation
Grade/
LOE
1. Diagnosis and evaluation
1.1 We suggest CTA as the initial diagnostic tool of choice for CAAs. 2-B
1.2 We suggest MRA in patients with suspected CAA and pre-existing
renal insufficiency, limiting the use of iodinated contrast material.
2-B
1.3 We suggest arteriography when noninvasive studies have not sufficiently
demonstrated the status of relevant collateral blood flow or when
endovascular intervention is planned.
2-C
2. Treatment indications, size criteria, and true vs. false aneurysms
2.1 We recommend emergent intervention for ruptured CAAs. 1-A
2.2 We recommend treatment of nonruptured celiac artery
pseudoaneurysms of any size in patients of acceptable operative risk
because of the possibility of rupture.
1-B
2.3 We recommend treatment of nonruptured celiac artery true aneurysms
>2 cm, with a demonstrable increase in size, or with associated
symptoms in patients of acceptable risk because of the risk of rupture.
1-C
2.4 We suggest observation over intervention for small (<2 cm), stable
asymptomatic CAAs or those in patients with significant medical
comorbidities or limited life expectancy.
2-C
3. Treatment options
3.1 In patients with ruptured CAA discovered at laparotomy, we
suggest ligation if sufficient collateral circulation to the liver can be
documented.
2-C
3.2 In patients with ruptured CAA diagnosed on preoperative imaging
studies who are stable, we recommend treatment with open surgical or
appropriate endovascular methods based on the patient's anatomy and
underlying clinical condition.
1-B
3.3 For the elective treatment of CAA, we suggest using an endovascular
intervention if it is anatomically feasible. However, elective treatment
may appropriately involve open surgical, endovascular, or laparoscopic
methods of intervention, depending on the patient's anatomy and
underlying clinical condition.
2-B
3.4 To determine the need for revascularization of the celiac artery and
its branches in treating CAA, we suggest evaluating the status of the
superior mesenteric artery, gastroduodenal artery, and other relevant
collateral circulation, which must be carefully documented on
preoperative CTA or angiography.
2-B
