Diagnosis and Management of Superior Mesenteric Artery Aneurysms: 5 cases

Hong, Chang Won; Lee, Jeong Hoon; Ha, Jongwon; Kim, Sang Joon

Abstract

PURPOSE
Superior mesenteric artery (SMA) aneurysms are rare but have a definite rupture risk. We reviewed our experience with 5 patients to try to determine how to manage SMA aneurysms. METHOD: A retrospective review was undertaken of the medical records of 5 patients with SMA aneurysms diagnosed and treated at Seoul National University Hospital (SNUH) over the past 12 years. Clinical presentation, diagnosis, aneurysm characteristics, management and outcome were reviewed. RESULT: The 5 patients with SMA aneurysms, 4 males and 1 female, had a mean age of 52.2 years (range: 38~66). One patient had ruptured at presentation. Four associated aneurysms were present in two patients. The etiologies were variable. The first was a systemic disorder, fibromuscular dysplasia associated with SMA aneurysm, the second and third were mycotic SMA aneurysms resulting from septic aortic and mitral valves, and the fourth and fifth were dissecting SMA aneurysms. Four patients presented with abdominal pain, the other with left calf tightness caused by an aneurysm of the left popliteal artery. All five patients underwent surgery. One patient died after three operations due to massive gastrointestinal bleeding.
CONCLUSION
Aneurysms of the superior mesenteric artery (SMA) are rare, constituting 5.5% of splanchnic artery aneurysms(1). Nevertheless, such aneurysms have a definite rupture risk, irrespective of size, and may be difficult to manage even in the elective situation. Thus, SMA aneurysms must be treated promptly at diagnosis to minimize morbidity and mortality. All SMA aneurysms should be repaired in patients at good operative risk. And interventions such as endovascular embolization or endoluminal stent grafting provide additional therapeutic options to those at poor operative risk.