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Mesenteric artery aneurysm

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The following summarized guidelines for the evaluation and management of mesenteric artery aneurysm are prepared by our editorial team based on guidelines from the Society for Vascular Surgery (SVS 2020), the American College of Gastroenterology (ACG 2020), and the European Society for Vascular Surgery (ESVS 2017).
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Guidelines

1.Screening and diagnosis

Indications for screening: consider screening for gastroduodenal artery and pancreaticoduodenal artery aneurysms with CTA or duplex ultrasound in patients with median arcuate ligament syndrome.
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2.Diagnostic investigations

Diagnostic imaging: as per SVS 2020 guidelines, obtain CTA as the diagnostic tool of choice in patients with suspected superior mesenteric artery, jejunal artery, ileal artery, colic artery, gastroduodenal artery, or pancreaticoduodenal artery aneurysms.
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  • Screening for vasculitis

  • Screening for other aneurysms

3.Medical management

Nonoperative management: consider offering medical treatment in patients with nonruptured, asymptomatic ileal, jejunal, of colic artery aneurysms associated with polyarteritis nodosa.
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4.Therapeutic procedures

Indications for repair: as per ACG 2020 guidelines, consider offering treatment in asymptomatic patients with aneurysms of the pancreaticoduodenal and gastroduodenal arcade, intraparenchymal hepatic artery branches, female patients of childbearing age, and recipients of a liver transplant, irrespective of aneurysm diameter.
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  • Endovascular repair

5.Surgical interventions

Surgical repair: as per SVS 2020 guidelines, consider performing open surgical ligation or aneurysm excision in patients with jejunal, ileal, or colic artery aneurysms when laparotomy is being considered for hematoma evacuation or bowel assessment for viability.
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6.Follow-up and surveillance

Follow-up imaging: as per ACG 2020 guidelines, obtain follow-up imaging initially in 6 months, then at 1 year and subsequently every 1-2 years in asymptomatic patients with mesenteric aneurysms < 2 cm in diameter (excluding aneurysms of the pancreaticoduodenal and gastroduodenal arcade, intraparenchymal hepatic artery branches, females of childbearing age, and recipients of a liver transplant).
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