SVS Guidelines Bundle

Visceral Aneurysms

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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

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