Successful resection of two simultaneous aneurysms of the superior mesenteric and right renal artery

Abstract

Aneurysms of the superior mesenteric artery are very rare with an estimated incidence of 0.008 per cent. 1 After the first successful resection of such an aneurysm in 1949 by Cooley and DeBakey 2 only 13 further successful operations were performed up to 1971. 3 Most of these aneurysms were mycotic associated with subacute bacterial endocarditis. 3 Aneurysms of the renal artery are also uncommon with a reported incidence between 0.1 to 0.76 per cent. 4-7 Their etiology is unclear, s-l° The successful surgical treatment of a combination of an aneurysm of the superior mesenteric artery and the renal artery has, to our knowledge, never been reported before. We report on a patient who underwent aorto-mesenteric and aorto-renal Gore-tex bypasses because of synchronous aneurysms of the right renal artery and the superior mesenteric artery, both of non-infectious etiology. Abdominal CT-scan and digital substraction angiography showed the correct diagnosis of an aneurysm of the superior mesenteric artery and the right renal artery, the latter only seen on angiography (Figs 1 and 2). A laparotomy was performed through a median incision and a degree of retroperitoneal fibrosis found with the vena cava and aorta tightly adherent to each other. Soft tissue and paraaortic lymph nodes were taken for histologic examination: in frozen section there were no signs of any infection and in paraffin section only histiocytosis of the lymph node sinus, and slight fibrosis of fatty tissue was found. After exposing the left renal vein, retracting the pancreas upward and dissecting the mesentery of the small intestine, a saccular aneurysm of the superior mesenteric artery 8 cm long and 4 cm diameter was found. After