Superior Mesenteric Artery Aneurysm Research Articles

Changing Nature of Endoleak in a Patient of Superior Mesenteric Artery Aneurysm Treated with Endovascular Stent Graft

Changing Nature of Endoleak in a Patient of Superior Mesenteric Artery Aneurysm Treated with Endovascular Stent Graft

Clinical and Molecular Characterization of a Novel Homozygous Frameshift Variant in AEBP1-Related Classical-like Ehlers Danlos Syndrome Type 2 with Comparison to Previously Reported Rare Cases.

Recently, an autosomal recessive subtype of connective tissue disorder within the spectrum of Ehlers-Danlos syndrome (EDS), named classical-like EDS type 2 (clEDS2), was identified. clEDS2 is associated with biallelic variants in the adipocyte enhancer binding protein 1 (AEBP1) gene, specifically, affecting its aortic carboxypeptidase-like protein (ACLP) isoform. We described the 15th patient (13th family) diagnosed with clEDS2. This patient presented with notable similarities in phenotype to the documented cases, along with additional characteristics such as significant prematurity and short stature. An EDS sequencing panel-based analysis revealed homozygous AEBP1: NM_001129.5:c.2923del, p.Ala975Profs*22 likely pathogenic variants, and maternally inherited heterozygous COL11A1: NM_001854.4:c.1160A>G, p.Lys387Arg variant of uncertain significance in our patient. Upon comprehensive review of all previously reported clEDS2 patients, our patient exhibited the following overlapping phenotypes, including cutaneous features: hyperextensibility, atrophic scars/delayed wound healing (100%), easy bruising (100%), excessive skin (93%); skeletal features: generalized joint hypermobility (93%), pes planus (93%), dislocation/subluxation (93%); and cardiovascular features (86%). Our patient did not display symptoms of the critical complications reported in a few individuals, including superior mesenteric artery aneurysms and ruptures, aortic root aneurysm/dissection, spontaneous pneumothoraxes, and bowel ruptures. Together, this case expands the genetic and clinical phenotypic spectrum of AEBP1-related clEDS2.

Angiotensinogen as a Therapeutic Target for Cardiovascular and Metabolic Diseases.

AGT (angiotensinogen) is the unique precursor for the generation of all the peptides of the renin-angiotensin system, but it has received relatively scant attention compared to many other renin-angiotensin system components. Focus on AGT has increased recently, particularly with the evolution of drugs to target the synthesis of the protein. AGT is a noninhibitory serpin that has several conserved domains in addition to the angiotensin II sequences at the N terminus. Increased study is needed on the structure-function relationship to resolve many unknowns regarding AGT metabolism. Constitutive whole-body genetic deletion of Agt in mice leads to multiple developmental defects creating a challenge to use these mice for mechanistic studies. This has been overcome by creating Agt-floxed mice to enable the development of cell-specific deficiencies that have provided considerable insight into a range of cardiovascular and associated diseases. This has been augmented by the recent development of pharmacological approaches targeting hepatocytes in humans to promote protracted inhibition of AGT synthesis. Genetic deletion or pharmacological inhibition of Agt has been demonstrated to be beneficial in a spectrum of diseases experimentally, including hypertension, atherosclerosis, aortic and superior mesenteric artery aneurysms, myocardial dysfunction, and hepatic steatosis. This review summarizes the findings of recent studies utilizing AGT manipulation as a therapeutic approach.

A clinical case of surgical treatment of a child with aneurysms of the abdominal aorta and aortic bifurcation, superior mesenteric artery and multiple aneurysms of the main arteries

A brief literature review on abdominal aortic aneurysms in children and our own observation of surgical treatment of a 5-year-old child with an aneurysm of the abdominal aorta and aortic bifurcation, an aneurysm of the superior mesenteric artery, and multiple aneurysms of the arteries of the lower extremities has been presented in the paper. Staged replacement of the aortic aneurysm and superior mesenteric artery with synthetic polytetrafluoroethylene prostheses was performed. The features of surgical interventions, difficulties and complications that the authors encountered during the treatment of the child are described.

Giant distal superior mesenteric artery aneurysm without symptoms

Giant distal superior mesenteric artery aneurysm without symptoms

Giant Superior Mesenteric Artery Aneurysm Treated by Endovascular Treatment in a Very Elderly Female

Superior mesenteric artery (SMA) aneurysms (SMAAs) are rare and account for approximately 7% of all visceral artery aneurysms. If the anatomical complexity permits and the patency of organ perfusion is allowed, then an endovascular approach is the first choice for minimally invasive procedures. We report the case of a 92-year-old female with a giant SMAA and challenging anatomy, including a short proximal sealing zone from the origin of the SMA and a short distal sealing zone from the hepatic artery bifurcation. In view of her advanced age, she was treated endovascularly with covered stents. Reintervention was required to correct a postoperative endoleak; however, a favorable outcome was achieved with endovascular therapy.

A Case Report on A Patient Presenting with Abdominal Pain Caused by A Large Superior Mesenteric Artery Aneurysm

A Case Report on A Patient Presenting with Abdominal Pain Caused by A Large Superior Mesenteric Artery Aneurysm

Treatment of stent rupture after endovascular treatment of superior mesenteric aneurysm with open surgery.

The progress of visceral artery aneurysms (VAAs) after the endovascular repair of artery aneurysms is often accompanies by the potential risks of stent fracture. The clinical reported cases of VAAs stent fractures with stent displacement were extremely rare but severe complication, particularly for the superior mesenteric artery aneurysm (SMAA). We here reported a 62-year-old female patient with recurrent symptoms of SMAA 2 years after the successful endovascular repair using coil embolization and two partial overlapping stent-grafts in SMAA. The open surgery was performed instead of secondary endovascular intervention. The patient experienced a good recovery. As one of the complications after endovascular repair, stent fracture maybe more dangerous than SMAA itself, the stent fracture after endovascular repair treated by open surgery with satisfactory results is alternative and feasible.

Aneurysm of The Superior Mesenteric Artery Associated With A Cardio-Renal Syndrome About A Case in Mali

The authors report a rare association of superior mesenteric artery aneurysm and cardio-renal syndrome is a complex clinical and therapeutic entity of cardiovascular and renal pathology whose prognosis depends on the precocity of management. We report a case of superior mesenteric artery aneurysm in a 36-year-old hypertensive patient, suffering from terminal renal failure complicating with stage 2 cardiorenal syndrome who underwent a hemodialysis session and a literature review.

Abstract 292: LRP1 Prevents Aortic And SMA Aneurysms By Modulating Excessive Ang-II Signaling

Objectives: LRP1 (low-density lipoprotein receptor-related protein 1) is known to contribute to vascular homeostasis and plays a protective role against the development of aneurysms. LRP1 has specifically been associated with abdominal aortic aneurysms in GWAS studies. We and others have also previously reported that mice with a conditional smooth muscle cell (SMC) knock-out of LRP1 (smLRP1-/-) exhibit vascular wall dysfunction and aortic dilation. In this study, we sought to investigate the molecular mechanisms by which LRP1 regulates vessel wall integrity in hopes of identifying potential therapeutic targets against aneurysm progression. Approach and Results: Analysis of proteomic data of the descending thoracic aorta, abdominal aorta, and superior mesenteric artery (SMA) of smLRP1-/- mice confirmed excess activation of the angiotensin signaling pathway. To verify these observations, we designed experiments to determine if losartan, an angiotensin-II receptor blocker, could prevent aneurysm progression in smLRP1-/- mice. Following treatment, we analyzed the aortic vasculature from LRP1+/+ and smLRP1-/- adult mice (16-weeks of age) with or without treatment. Without losartan, smLRP1-/- mice developed spontaneous aortic and SMA aneurysms as demonstrated by increased vessel dilation, vessel medial thickening and significant fragmentation of the elastic lamina. We found that when treated with losartan, smLRP1-/- mice had a complete restoration of medial layer thickness and a partial decrease of elastin fragmentation compared to untreated smLRP1-/- mice. Furthermore, losartan completely blocked SMA aneurysm formation in smLRP1-/- mice. Conclusions: Our findings suggest a critical role for LRP1 in maintaining vascular homeostasis and preventing aneurysm formation through its regulation of the angiotensin signaling pathway. Further studies will need to investigate the connection between LRP1 and the angiotensin signaling pathway in aneurysm formation to further understand the complex pathophysiology and potentially develop effective therapeutic targets for this disease.

Superior mesenteric artery aneurysm: treatment with endovascular techniques: case report

Superior mesenteric artery aneurysms (SMAA) are rare and associated with a high risk of rupture, morbidity and mortality. Their clinical presentation is heterogeneous, turning the clinical diagnosis into a difficult task-which can delay their treatment. We present a case of a patient with a SMAA, treated successfully with coil embolization.

Comparison of Superior Mesenteric Artery Remodeling and Clinical Outcomes between Conservative or Endovascular Treatment in Spontaneous Isolated Superior Mesenteric Artery Dissection.

The aim of this study was to analyze the superior mesenteric artery (SMA) remodeling after initial conservative or endovascular treatment with a standardized definition and midterm outcomes in patients with spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). This retrospective study enrolled patients with SIDSMA from January 2007 to August 2019. All patients were treated initially with conservative treatment. If they failed the medical treatment, they were converted to interventional treatment. The morphological endpoint was determined by the standardized SMA remodeling, and the clinical endpoints were determined by the in-hospital mortality, hospital stay, and the bowel-related mid-term mortality. A total of 34 consecutive patients with SIDSMA were identified. Twenty-three (67.6%) and eleven (33.4%) patients underwent conservative and interventional treatments, respectively. Clinical features and morphologic changes on CTA were available in 25 (73.5%) patients during the median follow-up of 23.3 months. Standardized SMA remodeling was significantly (p < 0.05) better in patients undergoing endovascular stenting, especially in patients with Yun’s IIb classification. There was no mesenteric ischemia or SMA aneurysm during follow-up period. Patients with SIDSMA can be treated safely with initial conservative treatment. However, significant portions of patients will require endovascular intervention due to the persistent symptoms. Clinically endovascular stenting could be performed successfully, and SMA remodeling was satisfactory during the mid-term follow-up.

Low-density Lipoprotein Receptor-related Protein 1 Prevents Aortic and Superior Mesenteric Artery Aneurysms by Modulating Excessive Angiotensin II Signaling

Low-density Lipoprotein Receptor-related Protein 1 Prevents Aortic and Superior Mesenteric Artery Aneurysms by Modulating Excessive Angiotensin II Signaling

Superior mesenteric artery aneurysm

We report surgical treatment of 4 patients with superior mesenteric artery aneurysm. A comprehensive examination including Doppler ultrasound and CT angiography of visceral arteries made it possible to assess the features of vascular anatomy. In accordance with the peculiarities of upper mesenteric artery angioarchitectonics, open and endovascular methods were used. A differentiated approach made it possible to treat patients without any complications.

Surgical treatment of superior mesenteric artery aneurysm and dissection in a child with Ehlers-Danlos syndrome type IV

Surgical treatment of superior mesenteric artery aneurysm and dissection in a child with Ehlers-Danlos syndrome type IV

Superior mesenteric artery aneurysm due to fibromuscular dysplasia: diagnosis and surgical treatment

Superior mesenteric artery aneurysm due to fibromuscular dysplasia: diagnosis and surgical treatment

Acute necrotizing pancreatitis as a manifestation of Behcet’s Disease: A case report and review of the literature

BackgroundBehçet’s disease (BD) is a chronic, relapsing, multisystemic vasculitis with varying frequency of gastrointestinal manifestations. Pancreatitis is a rare manifestation of BD. Case presentationA 31-year-old man diagnosed with Behçet’s disease with a fiveyear history of recurrent orogenital ulcers, ocular involvement and pseudofolliculitis presented with severe epigastric pain radiating to back that worsens after meals and weight loss (10 kg in 3 months). He denied history of abdominal trauma, drug abuse or alcohol consumption. He was found to be hypertensive. Laboratory investigations revealed presence of leukocytosis, thrombocytosis, high inflammatory markers, low serum albumin, impaired renal functions, hyperglycemia and elevated serum amylase. Post contrast triphasic computed tomography scan showed a picture of necrotizing hemorrhagic pancreatitis. Bile and pancreatic ducts were normal. CT mesenteric angiography showed no evidence of aortic, celiac or superior mesenteric artery aneurysms, also splenic artery and veins were patent with no evidence of occlusion. After exclusion of other causes of acute pancreatitis, the condition has been attributed to BD. High dose of oral corticosteroids was started (60 mg/day) in addition to proper hydration, antihypertensive medications, intravenous antibiotics and insulin to control elevated blood sugar. Cystogastrostomy through endoscopic ultrasound was done to relieve the patient’s pain. Unfortunately, three months after the onset of pain, the patient developed systemic inflammatory response syndrome and passed away. ConclusionAlthough acute pancreatitis is a rare gastrointestinal manifestation of BD, it is a possibly fatal one.

Preoperative Planning for Superior Mesenteric Artery Aneurysm

Surgical procedures on various artery aneurysms are difficult to perform and require careful preparation. We have developed and now present in this paper a software platform, CardioCTNav, that can help in planning such procedures. The planning consists of a 3D rendering of the area of interest, virtual angiography, automated measurements, and virtual stent simulation.

A Hybrid Approach to Treatment of a Superior Mesenteric Artery Aneurysm

Superior mesenteric artery (SMA) aneurysms represent ∼6% of mesenteric aneurysms and carry a risk of rupture. These can be repaired with open surgery or endovascular repair. We present the case of a patient who had developed aneurysmal degeneration of the SMA after dissection requiring hybrid open and endovascular repair. A 54-year-old man had presented to the emergency department with epigastric pain. He was noted to have a 7-cm-long SMA dissection with aneurysmal dilatation. He was treated nonoperatively with anticoagulation and serial imaging until his SMA aneurysm had increased to 2 cm. Preoperative imaging showed the patient had two major jejunal branches originating from the true lumen, with the remaining branches fed from the false lumen. In addition, the aneurysm degeneration extended through the SMA to just distal to the origin (Fig 1). Because of this complex anatomy, we believed a hybrid approach would be needed with a short interposition bypass, reimplantation of jejunal branches, and covered stent placement for proximal coverage. The patient underwent laparotomy with anterior exposure of the SMA. After establishing proximal and distal control, a longitudinal arteriotomy was made. The true and false lumens were noted and fenestrated. An 8-mm polytetrafluoroethylene graft was sewn in an end to end fashion. This was followed by reimplantation of the two jejunal branches as a patch. Flow was confirmed with Doppler ultrasound. Next, the polytetrafluoroethylene graft was accessed with a needle, and a sheath was placed. Angiography and intravascular ultrasound were used to confirm and delineate the anatomy. Next, we upsized to an 8F sheath and placed two 10 × 5 Viabahn stents (W.L. Gore & Associates, Flagstaff, Ariz) overlapping into the aorta and covering the proximal SMA. We postdilated with a 9-mm balloon. Completion imaging revealed good flow with exclusion of the aneurysm (Fig 2). The bowel appeared healthy at that time. The patient tolerated the procedure well and was extubated at the conclusion of the case. He required a nasogastric tube postoperatively until the return of bowel function, at which point he was allowed a regular diet. He was discharged home in sTable condition on postoperative day 6 from the hospital. A hybrid approach to complex SMA aneurysms is a feasible option for repair.Fig 2Completion angiogram at conclusion of the case.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Aneurysmal Dilatation of a Variant of Hepatosplenomesenteric Origin

Superior mesenteric artery (SMA) aneurysms are rare and often asymptomatic but can have catastrophic disease progression. Rare, and with anatomic variations of the celiac axis relatively common, management of SMA aneurysms is patient specific. We report the management of an aneurysmal dilatation of a variant with a hepatosplenomesenteric origin.