Update on aneurysm disease: current insights and controversies: peripheral aneurysms: when to intervene - is rupture really a danger?

Abstract

Peripheral artery aneurysms are rarer than abdominal aortic aneurysms (AAA), although the true prevalence is not well known. They often coexist with aortic and other peripheral artery aneurysms. In contrast to AAA, where the principal risk is that of rupture, thromboembolism is more common, contributing a bigger risk in the more common lesions. Although rupture does occur, with incidence related to anatomical site, aneurysm diameter cannot be used to guide management with the same confidence as in AAA. In addition, the rarity of these lesions results in a paucity of evidence with which to guide intervention. Consequently they are difficult lesions to manage, and numerous aneurysm and patient factors must be considered to provide treatment individualised for each case. We discuss popliteal, femoral, carotid, subclavian, upper limb, visceral and false aneurysms, focussing on the risk of rupture and thromboembolism, and current thresholds for intervention, based on the available published literature.

Keywords: AAA; Aneurysm; CAA; CCA; CFAA; DVT; ECA; ECAA; EVAR; FA; FAA; False aneurysm; HAA; ICA; IVDU; PAA; PFAA; Popliteal aneurysm; SAA; SCA; SFAA; TAVI; TEVAR; VAA; abdominal aortic aneurysm; coeliac artery aneurysm; common carotid artery; common femoral artery aneurysm; deep vein thrombosis; endovascular aneurysm repair; external carotid artery; extracranial carotid artery aneurysm; false aneurysm; femoral artery aneurysm; hepatic artery aneurysm; internal carotid artery; intravenous drug use; popliteal artery aneurysm; profunda femoral artery aneurysm; subclavian artery; subclavian artery aneurysm; superficial femoral artery aneurysm; thoracic endovascular aneurysm repair; transcatheter aortic valve implantation; visceral artery aneurysm.