June 16, 2020
SVS Publishes Clinical Practice Guidelines on the Management of Visceral Aneurysms
June 16, 2020—The Society for Vascular Surgery (SVS) has released new clinical practice guidelines on the appropriate care and treatment of aneurysms of the visceral arteries. The guidelines were published by Rabih A. Chaer, MD, et al in a supplement to Journal of Vascular Surgery (2020;72:3S-39S).
The society explained that these clinical practice guidelines provide guidance to vascular surgeons who treat patients with aneurysms of the renal and visceral arteries. They advise that the ultimate treatment goal should be to prevent aneurysm expansion and potential rupture by exclusion from the arterial circulation, while maintaining necessary distal or collateral bed perfusion.
The SVS evidence-based practice guidelines offer recommendations to inform the diagnosis, treatment options, screening, and follow-up of visceral aneurysms. The guidelines include evidence-based size thresholds for repair of aneurysms of the renal arteries, splenic artery, celiac artery, and hepatic artery, among others. Open surgical and endovascular repair strategies are described as well as specific circumstances in which aneurysms may be considered for repair at a smaller size, such as in women of childbearing age. False aneurysms are also discussed.
According to SVS, of all intra-abdominal aneurysms, visceral arteries affect only 5% of cases. The clinical significance of visceral artery aneurysms, which include both true aneurysms and pseudoaneurysms, is mainly related to their potential for rupture and, once that happens, the challenges of diagnosis and treatment.
Dr. Chaer commented in the SVS announcement, “Nearly one-fourth of visceral artery aneurysms reported have presented with rupture, and the mortality rate of these diagnosed ruptures is at least 10%, probably higher. The mortality following ruptured celiac artery aneurysms and ruptured splenic artery aneurysms in pregnant women approaches 100%.”
The announcement noted that with the increased use of sophisticated forms of intra-abdominal imaging, including MRI, MRA, CT scans, and CTA, occult visceral artery aneurysms are being diagnosed with increased frequency.
“The detailed imaging studies have allowed for an improved ability among vascular surgeons to identify asymptomatic lesions and an enhanced potential for preoperative or preprocedural planning and elective treatment of these aneurysms,” stated Dr. Chaer. “Improvements in endovascular therapies have also allowed an enhanced ability for treatment of these often anatomically complex lesions with a large variety of individualized and precise catheter-based therapies.”