Two-Graft Repair of Very Proximal Superior Mesenteric Artery Aneurysms: A Technical Note

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.

Mesenteric autotransplantation: an alternative technique for reoperation and bypass of the superior mesenteric artery

Superior mesenteric artery (SMA) aneurysms represent a minority of visceral aneurysms but may result in lethal complications if left untreated. Options for treatment include aneurysmorraphy, bypass, ligation, or embolization. Here we present a case of a man with a history of celiac graft thrombosis who presents with a recurrent symptomatic SMA aneurysm. Given his compromised celiac axis, ligation was not an option. His SMA aneurysm was repaired with a PTFE patch. However, to secure longstanding blood flow to the small bowel in the event of graft thrombosis, the distal SMA pedicle was dissected free of the ileocolic vessels and anastomosed to the aorta. Follow-up studies demonstrated an occluded PTFE patch with a patent SMA autotransplant. This case depicts a novel approach to the surgical management of complex recurrent SMA aneurysms.