Endovascular Management of Superior Mesenteric Artery (SMA) Aneurysm – Adequate Access is Essential for Success – Case Report

Abstract

SummaryBackgroundAn aneurysm of the superior mesenteric artery (SMA) with a diameter of 2.2 cm was found incidentally on an ultrasound (US) examination in a 26-year-old woman. The only known risk factor was an intracranial aneurysm that was found on her grandmother’s autopsy. Based on pregnancy planning and the current literature, endovascular management with a covered stent was proposed.Case ReportSelf-expandable, covered stent (Bard, Fluency®) was implanted using a single transfemoral approach. A stiff guidewire and a large sheath distorted the anatomy, which resulted in an incomplete aneurysmal neck covering. In the absence of additional covered stents, the procedure was terminated. Two weeks later, computed tomographic angiography (CTA) confirmed persistent aneurysmal perfusion due to the incomplete neck coverage. A multidisciplinary board opted for a second endovascular attempt, this time with a longer covered stent via the transaxillary approach in order to reduce anatomical distortion. Balloon, expandable, cobalt-chrome covered stent (Jotec, E-ventus BX®) was implanted in the SMA, covering the aneurysmal neck and overlapping the previously implanted covered stent. Angiography confirmed a complete exclusion of the aneurysm.A control US performed three weeks later confirmed a patent covered stent and complete aneurysmal exclusion. There was a mild median nerve damage periprocedurally that resolved in three months. The most recent US control examination, performed eleven months after the procedure, showed an excluded aneurysm and a patent covered stent. There were no clinical signs of bowel ischaemia during the follow-up period.ConclusionsEndovascular management of SMAA proved to be safe and efficient. The “access from above” is probably safer and should be considered in the majority of cases with acceptable sizes of access vessels. Mid-term results in our patient are good and life-long follow-up is planned to prevent late complications.

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

“…Smaller visceral artery aneurysms, those less than 2 cm in diameter, are sometimes subject to "watchful waiting" and checked periodically for any signs of growth. In addition, calcified arterial walls on x-rays might raise the suspicion of an aneurysm [24]. Coupled with abnormal changes in the surrounding organs and tissues, such as signs of chronic pancreatitis along with stomach or flank pain, suggest the presence of a VAA.…”

Preoperative Planning for Superior Mesenteric Artery Aneurysm

“…They occur predominantly in men who are in the 5th decade of life. Aneurysmal degeneration of the superior mesenteric artery does not occur frequently, but when it does, it may result in mesenteric ischemia or rupture [4], which can initiate a potentially life-threatening condition [3]. In about 25% of cases, visceral aneurysms present as surgical emergencies [1], although the disease is often asymptomatic.…”

Surgical resection of a ruptured transverse pancreatic artery aneurysm

“…Visceral artery aneurysms are rare, but rupture can be life threatening [ 1 ]. Of patients with visceral artery aneurysms, 22% are diagnosed after rupture, resulting in misdiagnosis due to different clinical conditions and high mortality rates of 8.5–25% [ 2 – 4 ]. Aneurysms originating from the superior mesenteric artery (SMA) account for only 1% of visceral artery aneurysms and their diagnosis is markedly difficult.…”