Superior Mesenteric Artery Aneurysm Research Articles

Takayasu's Arteritis-associated Superior Mesenteric Artery Aneurysm Treated by Stent-graft Implantation via the Common Carotid Artery

Takayasu's Arteritis-associated Superior Mesenteric Artery Aneurysm Treated by Stent-graft Implantation via the Common Carotid Artery

Takayasu's Arteritis-associated Superior Mesenteric Artery Aneurysm Treated by Stent-graft Implantation via the Common Carotid Artery

Introduction Complications of Takayasu's arteritis are usually ischemia of certain organs caused by progressive arterial narrowing, while dilative lesions or formation of aneurysms are relatively uncommon. Report A 43-year-old man with the chief compliant of abdominal discomfort underwent an enhanced computed tomography scan which showed a 30 mm × 23 mm superior mesenteric artery aneurysm. Because of the acute downward angulation of the superior mesenteric artery and inappropriateness for larger sheath placement brachial arteries, the aneurysm was excluded with a stent-graft via the common carotid artery approach. Discussion Stent-graft implantation through the common carotid artery is a feasible approach for the endovascular treatment of superior mesenteric artery aneurysms when unfavorable anatomic limits exist.

Multiple Overlapping Bare Stents for Endovascular Visceral Aneurysm Repair: A Potential Alternative Endovascular Strategy to Multilayer Stents

Multilayer stent has become a new endovascular strategy for visceral artery aneurysm repair. However, its use was not allowed in some areas, such as China. This study evaluates an alternative method: multiple overlapping bare stents for repairing visceral artery aneurysms. Twenty-four patients with celiac artery aneurysm (n = 2), splenic artery aneurysm (n = 8), hepatic artery aneurysm (n = 3), superior mesenteric artery aneurysm (n = 6), and renal artery aneurysm (n = 5) were treated with 2 to 4 overlapping bare stents. Long-term results, including clinical achievement ratio and target artery patency, were followed up with computed tomographic angiography. Insertion of overlapping bare stents was successful in all patients. Five aneurysms (21%) were totally excluded 3 months after operation, increasing to 12 (50%) and 20 (83%) aneurysms with total isolation at 6 and 12 months' follow-up, respectively. The clinical achievement ratios of multiple overlapping bare stents on splenic artery aneurysms, hepatic artery aneurysms, renal artery aneurysms, celiac artery aneurysms, and superior mesenteric artery aneurysms were 75%, 100%, 80%, 50%, and 100%, respectively. All cases combined had 100% target artery patency. Preliminary experience showed that repair using multiple overlapping bare stents seemed to be a potential alternative strategy for treating visceral artery aneurysm, resulting in target artery patency. However, the exact mechanism requires further study and more cases should be involved.

Unusual upper gastrointestinal bleeding: Ruptured superior mesenteric artery aneurysm in rheumatoid arthritis

This case report describes an unusual case of upper gastrointestinal (UGI) bleeding caused by a ruptured superior mesenteric artery (SMA) aneurysm in the duodenum in a patient with rheumatoid arthritis. The patient presented with UGI bleeding and hemorrhagic shock. Emergency UGI endoscopy could not identify the source of the bleeding because of excessive blood clots under the second portion of the duodenum. An SMA aneurysm with active contrast extravasation was diagnosed by computed tomography. The aneurysm, together with the fourth portion of the duodenum and the proximal portion of the jejunum, was surgically resected, and the SMA was skeletonized. On postoperative day 15, the patient was discharged from hospital under satisfactory conditions. Rheumatoid arthritis has been known to cause a wide spectrum of manifestations, and an SMA aneurysm is an unusual extra-articular manifestation. An SMA aneurysm rupture presenting as upper gastrointestinal bleeding is a rare complication with a high mortality rate. The clinician must be alert to this potential issue to achieve rapid diagnostic confirmation, and immediate surgical or radiological intervention.

Single-Stage Endovascular Treatment Performed on Multiple Aortic Aneurysms in a Patient with Behçet’s Disease—Report of a Case

A 50-year-old male diagnosed with Behçet's disease was referred to our department for stent graft treatment because of thoracic, abdominal, and right common iliac artery (CIA) aneurysms. He had a superior mesenteric artery aneurysm in 2005 that was treated with resection and bypass surgery through the radial artery. He later underwent four abdominal surgical procedures for conditions such as intestinal perforation and ileus. Stent graft treatment was performed. The postoperative course was uneventful; postoperative computed tomography (CT) showed no apparent endoleak, while that performed at 3 years post-discharge showed that the aneurysms had decreased in size.

Giant Superior Mesenteric Artery Aneurysm with a Chief Complaint of Intermittent Backache

Giant Superior Mesenteric Artery Aneurysm with a Chief Complaint of Intermittent Backache

Abdominal catastrophe in infective endocarditis

A 49-year-old male with Type II diabetes mellitus presented with fever for 3 months and on evaluation was found to have infective endocarditis involving the aortic valve. Blood culture grew Streptococcus viridans. He was treated with intravenous antibiotics and improved clinically. He developed severe abdominal pain with vomiting and minimal clinical signs on the tenth day of hospitalization. CT abdomen showed a 3.3 cm × 1.6 cm lobulated aneurysm of the distal superior mesenteric artery (SMA) along with early ischemic changes of the small bowel (Figs. 1 and 2).

Superior mesenteric artery aneurysm in a 9‐year‐old boy with classical Ehlers–Danlos syndrome

A 9-year-old boy with the classical type of Ehlers-Danlos syndrome (EDS) developed a symptomatic aneurysm of the superior mesenteric artery. His EDS diagnosis had been confirmed biochemically and genetically. Vascular complications are known to be associated with the vascular type of EDS, but this is the first report of a child with classical EDS who developed a major vascular complication. Clinicians should be aware that severe vascular complications albeit rare, can also occur in classical EDS.

Superior Mesenteric Artery Aneurysm Due to Chronic Aortic Dissection

Epigastrik agrinin sebepleri arasinda superior mezenterik arter anevrizmasi nadir olarak bildirilmistir. Ellidokuz yasinda kadin hasta 2 haftadir olan epigastrik agrisi nedeniyle klinigimize basvurdu. Hastanin hikayesinde 3 yil once DeBakey tip I aortic diseksiyonu nedeniyle benthall proseduru uygulandigi ogrenildi. Bizde hastamiza cerrahi operasyona gerek kalmadan basariyla endovaskuler stent uyguladik. Ozellikle yuksek riskli hastalarda superior mezenterik arter anevrizmasinin tedavisinde endovaskuler tedavi secenegi oncelikli olarak dusunulmelidir.

Asymptomatic aneurysm of the superior mesenteric artery

Visceral artery aneurysms (VAAs) represent approximately 1–2% of all vascular aneurysms. Improvements in imaging technology have led to increased aneurysm detection in asymptomatic patients. A timely proper diagnosis and management of VAAs is essential to avoid the risk of acute rupture and associated mortality. We present a case of an asymptomatic 59-year-old patient with superior mesenteric artery aneurysm, who was successfully treated with endovascular embolization of the aneurysmatic sac.

A 6.5-cm pseudoaneurysm of the superior mesenteric artery managed by primary surgical repair

Superior mesenteric artery (SMA) aneurysms are rare but associated with significant mortality (25-40%) when complicated by rupture or thrombosis. Symptomatic SMA aneurysms, asymptomatic aneurysms of ≥2 cm size and pseudoaneurysms need intervention. We report a case of a 6.5-cm symptomatic SMA aneurysm managed by open surgical repair. At intraoperative exploration, the aneurysm was recognized to be a pseudoaneurysm with a narrow neck (1 mm defect in the native vessel) and was dealt by primary repair. Clinical presentation, the role of radiological investigations and management are discussed. Detailed preoperative assessment of the anatomical characters is essential in planning the intervention for SMA aneurysms. The required information can be obtained by selective interventional angiogram or computed tomographic angiogram with three-dimensional reconstruction. Multi-institutional prospective databases might provide better evidence regarding the timing of intervention, treatment modality, postinterventional follow-up and surveillance of patients with mesenteric aneurysms.

Superior Mesenteric Artery Mycotic Aneurysm in Patients With Left Ventricular Assist Device Support and Intravenous Drug Abuse

Mycotic aneurysm of the superior mesenteric artery (SMA) is one of the complications associated with infective endocarditis. However, there are no previous case reports in the literature describing mycotic SMA aneurysm after left ventricular assist device (LVAD) implantation. We describe the case of a 31-year-old male diagnosed with congestive heart failure due to nonischemic dilated cardiomyopathy who underwent LVAD implantation for bridge to heart transplantation. The postoperative course was uneventful, and the patient was maintained on anticoagulation and antiplatelet therapy. There were no signs of pump failure or device-related infections. However, 7 months post-LVAD support, the patient complained of abdominal symptoms (nausea and vomiting) with low-grade fever. Computed tomography identified an aneurysmal change of the SMA (2.2 × 1.8 cm). There was no evidence of thrombus or septic vegetation inside the heart. Aneurysm and segmental small bowel resection was performed. Pathological study revealed typical findings of mycotic aneurysm with significant infiltration of inflammatory cells. The patient, however, expired due to concurrent brain hemorrhage. Postmortem study indicated no sign of pump thrombus or septic emboli inside the pump or inflow/outflow conduit. This case report presents a rare mycotic aneurysm that developed in the SMA after chronic LVAD support.

Endovascular Stent–Graft Repair of a Symptomatic Superior Mesenteric Artery Aneurysm

Aneurysms of the visceral branches of the abdominal aorta are uncommon and potential life-threatening entities. Although hepatic and splenic artery aneurysms have the highest prevalence among splanchnic aneurysms, superior mesenteric artery aneurysms are even more uncommon. For ruptured visceral arteries aneurysms, a mortality rate of between 20% and 100% has been reported. Besides rupture, the aneurysms can also erode into adjacent visceral organs, which results in severe hemorrhage. Emergency surgery of visceral artery aneurysms is related with significant mortality. In recent years, endovascular therapies have been successfully established in the elective setting. Therefore, we adopted the endovascular stent-graft insertion technique for dealing with an acute symptomatic aneurysm of the superior mesenteric artery. We report the case of a 79-year-old male patient with a symptomatic aneurysm of the proximal superior mesenteric artery. Using an endovascular approach, the aneurysm was excluded with an endoluminal stent--graft. The endoluminal stent--graft repair resulted in total exclusion of the aneurysm. Patency of the superior mesenteric artery continued and no ischemic complications occurred. Pain and other symptoms disappeared and the patient recovered entirely. Endovascular management of symptomatic superior mesenteric artery aneurysm is feasible and may display excellent results in selected cases. Therefore, endoluminal stent--graft repair should be considered as an alternative to traditional surgical treatment. However, in each patient, the individual anatomy of the mesenteric circulation and the location of the aneurysm play a major role in determining whether endovascular management is possible or surgical repair should be preferred.

Is Open Repair Still the Gold Standard in Visceral Artery Aneurysm Management?

Visceral artery aneurysms and pseudoaneurysms represent a rare disease with high mortality. The aim of this study was to report a single center experience of open repair (OR) and endovascular treatment (ET) of 94 patients, and to analyze short- and midterm results. Between 1988 and 2010, 94 patients, 43 men and 51 women, mean age of 57.6 years (range, 23-87 years), were referred to our Institute with a diagnosis of visceral artery aneurysm or pseudoaneurysm. Arteries involved were splenic artery in 44 cases, hepatic artery in 17, renal artery in 18, superior mesenteric artery in six, celiac trunk in three, gastroduodenal in two, and pancreaticoduodenal in four. An abdominal aortic aneurysm coexisted in three (3%) cases, whereas in six (6%) cases, there were multiple visceral aneurysms. ET was indicated based on the anatomical location of the aneurysm or for patients at high risk for surgery. A total of 74 patients underwent OR, whereas ET was performed in 20 patients. Technical success was achieved in all cases treated by open surgery. Splenectomy was performed in 11 cases, and in six, splenic autotransplantation was performed. At 6 months of follow-up, a Tc99m-labeled red cell scintigraphy showed that autotransplants were viable in four patients (67%). No cases of pancreatitis or splenic infarction were observed. Among renal artery aneurysms, nephrectomy was necessary in one case of renal infarction for massive thrombosis of the ex-vivo reconstructed renal artery. Four surgical conversions were recorded (one thrombosis of the hepatic artery, one massive hemorrhage after embolization of superior mesenteric artery aneurysm, and two cases of sac enlargement after 24 and 48 months). An endoleak was present in a patient treated for a splenic artery aneurysm, but it resolved spontaneously after 6 months. No complications were observed in patients undergoing surgical conversion after ET. Perioperative mortality in the surgical group was 1.3% (1/74). There was no perioperative mortality in the endovascular group. No statistically significant difference was found between groups in terms of perioperative mortality (p = 1.00). Perioperative morbidity was 9.4% (7/74) in the surgical group, and 10% (2/20) in the endovascular group (p = 1.00). Follow-up was available for 16 patients in the endovascular group (80%) and 63 in the surgical group (85%), with a mean duration of 42 months (1-192 months). In the whole cohort, actuarial survival at 10 years was 68%. The Kaplan-Meier estimates of survival at 1 and 5 years were 100% and 85%, respectively, for OR, and 100% and 40%, respectively, for ET, with no significant difference between the two groups ET is safe and feasible in selected patients, but incomplete exclusion may be observed, requiring late surgical conversion in a significant number of patients. Long-term results (high survival, low complication rate) confirm the durability of the surgical approach that in our experience remains the gold standard with satisfactory results, especially for aneurysms involving the visceral hilum.

Current strategy for the treatment of symptomatic spontaneous isolated dissection of superior mesenteric artery

Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is extremely rare. Various treatment options are currently available, including conservative management, anticoagulation, endovascular stenting, and surgical repair. Herein, we present our experience in the treatment of symptomatic SIDSMA. A retrospective study was conducted on 14 consecutive patients with symptomatic SIDSMA between January 2000 and January 2010. All patients had acute onset abdominal pain. The decision to intervene was based on patient symptoms and signs, as well as the morphologic characteristics of superior mesenteric artery (SMA) dissection on computed tomography (CT) angiography. Endovascular stenting (ES) was indicated in patients with severe compression of the true lumen or dissecting aneurysm likely to rupture. Self-expandable stents were placed via a right common femoral approach. None of the patients underwent anticoagulation, and patients who underwent ES were maintained on antiplatelet therapy for 3 months postoperatively. The median age of the study subjects was 59 years (range, 50-75 years). The median follow-up time was 27.5 months (range, 2-64 months). Treatment included conservative management without the use of anticoagulation in seven patients, ES in six, and necrotic bowel resection in one. Four patients with severe compression of the true lumen or large dissecting aneurysm underwent ES as a primary treatment. ES was additionally performed in two patients in whom initial conservative treatment failed (increasing dissecting aneurysm at 7-day follow-up CT scan in one and a reappearance of abdominal pain after resuming diet in the other). The median fasting time was significantly shorter in patients with primary ES (2.5 days) than in those managed conservatively (8.0 days). No complications associated with the SIDSMA or ES were developed. The patency of stents was demonstrated on follow-up CT scans up to 60 months (range, 1-60 months). Conservative management without anticoagulation can be applied successfully to the patients with symptomatic SIDSMA. Primary endovascular stenting is indicated if patients have suspected bowel ischemia, compression of the true lumen of the SMA >80%, or SMA aneurysm of >2.0 cm in diameter on initial CT scan. Endovascular stenting can also be provided to the patients in whom initial conservative treatment failed, as a rescue therapy.

Therapeutic management of superior mesenteric artery aneurysms

Superior mesenteric artery (SMA) aneurysms are rare but life-threatening entities. This study summarizes our experience in providing therapeutic management for true aneurysms of the SMA. Between February 1998 and March 2010, 10 patients were diagnosed with true SMA aneurysms in our hospital. Medical data for demographics, clinical presentation, diagnosis, aneurysm characteristics, treatment modalities, outcomes, and follow-up were retrospectively analyzed. Ten patients (six women, four men) were enrolled with a mean age of 56.7 years (range, 42-69 years). One patient (10%) had aneurysm rupture and presented with abdominal pain, and seven (70%) were asymptomatic. The size of nonruptured aneurysms ranged from 1.2 to 8.0 cm (mean, 3.5 cm). Of 10 patients, five received endovascular stent graft repair, two were treated surgically, two were observed, and one with aneurysm rupture died of hemorrhagic shock before surgery. The two surgical patients underwent SMA reconstruction after aneurysmectomy, and segmental bowel resection was performed in one patient after reconstruction. The overall mortality rate was 10%. Postoperative gastroparesis was identified in one patient (14.3%). Mean operation time was 3.6 hours in the surgical group and 1.3 hours in the endovascular group. Mean postoperative hospital stay for the two groups was 20.0 days and 2.2 days, respectively. Mean follow-up was 30.9 months (range, 3-72 months). Endoleak was found in one patient 3 months after endovascular repair. True SMA aneurysms are uncommon entities with definite rupture risk and mortality. Compared with surgical intervention, endovascular stent graft placement is associated with less trauma and rapid recovery. It may be a promising alternative to surgical intervention. The most appropriate treatment depends on the characteristics of the lesion and the condition of the patient.

Mycotic aneurysm of the superior gluteal artery in a patient with bacterial endocarditis: case report and review of the literature

Mycotic aneurysm of the superior gluteal artery (SGA) is extremely rare. The review of the literature revealed only five cases of mycotic SGA aneurysms reported to date and none had a concomitant superior mesenteric artery (SMA) aneurysm. We describe a 64-year-old man with mycotic aneurysms of both the SGA and the SMA. The patient was referred to our hospital because of SMA embolism caused by bacterial endocarditis following mitral valve plasty. He was treated conservatively, but monitoring using computerized tomography (CT) scanning showed the development and growth of the SGA and the SMA aneurysms. The SMA aneurysm was resected surgically, and the SGA lesion was treated by means of selective embolization. For the treatment of SGA aneurysms, prompt and precise preoperative evaluation is important. When the anatomical feature and size of the aneurysm is suitable, endovascular treatment may be the first-line treatment, providing an efficacious and safe alternative to traditional surgical repair.

Mycotic superior mesenteric pseudoaneurysm draining into a vein

A 46-year-old man with a medical history notable only for schizophrenia was admitted to hospital with complaints of general fatigue and high fever. Transthoracic echocardiography on day 6 after admission demonstrated a large vegetation (17 mm) on the anterior leaflet of the mitral valve with mild regurgitation and mild aortic regurgitation. The patient also complained of abdominal pain. Abdominal computed tomography showed a remarkable enlargement of the superior mesenteric artery aneurysm (SMAA). An excision of the SMAA and double valve replacement was performed, and the patient was administered a six-week course of intravenous antibiotic therapy.

Superior Mesenteric Artery Aneurysm

Splanchnic aneurysms are uncommon conditions with an unpredictable and a potentially severe evolution, 1,2 The incidence of splanchnic aneurysms is reported to be between 0.1%3 and 10%, 4 and they may be rarely associated with abdominal aortic aneurysms. 5 Given the high mortality rate (25%-75%), early diagnosis is mandatory. 4,6 Therefore, the recommended management is prophylactic surgical treatment or interventional radiologic embolization shortly after diagnosis, especially if the aneurysmal diameter is larger than 2 cm. 4,5 Imaging techniques are essential in the diagnostic process, and sonography is often the first step. We report the case of a superior mesenteric artery aneurysm in which imaging techniques had a decisive role in diagnosis.

Concomitant Symptomatic Aneurysms of Celiac Trunk and Superior Mesenteric Artery

A 64-year old man with intermittent, paraumbilical pain which is lasting for 6 months, radiating to the back with no other symptoms underwent resection of the celiac trunk and superior mesenteric artery aneurysms. According to their size and location the aneurysms were not suitable for radiological embolisation or stentnig. Elective surgical procedure was performed. End-to-end anastomosis was created between the origin of the celiac trunk and splenic artery and the vascular continuity of the superior mesenteric artery was achieved using great saphenous vein interpositum. Intraoperative samples and histological findings were consistent with atherosclerosis. The patient made a good recovery and remained well after 2 years.