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Cardiology118 papers

Atherosclerosis of superior mesenteric artery

Last edited: 4/23/2026

Overview

Atherosclerosis affecting the superior mesenteric artery (SMA) leads to occlusive lesions, potentially causing ischemic symptoms in the gastrointestinal tract through thrombosis or embolization 1.

Diagnosis

  • Imaging studies (CT angiography, MR angiography) to identify occlusive lesions 1
  • Clinical assessment for ischemic symptoms in the abdomen or bowel 1
  • Laboratory tests to evaluate platelet function and coagulation status 1

    • Management

  • Pharmacological:
    • - Antiplatelet therapy: low-dose aspirin or clopidogrel 1 - Anticoagulation for cardioembolic disease: warfarin or direct oral anticoagulants (DOACs; apixaban, dabigatran, edoxaban, rivaroxaban) 1 - Blood pressure control <140/90 mmHg using ACE-inhibitors, angiotensin receptor blockers, beta-blockers, calcium channel blockers, or thiazide diuretics 1 - LDL-cholesterol reduction <1.8 mmol/l with statins 1
  • Non-pharmacological: Smoking cessation, glycemic control in diabetic patients 1

    • Special Populations

  • Comorbidities: Management strategies similar for patients with diabetes, focusing on metabolic control 1
  • Smoking cessation: Strongly recommended for all patients 1

    • Key Recommendations

  • Initiate antiplatelet therapy with low-dose aspirin or clopidogrel for patients with SMA atherosclerosis 1 (Evidence: Strong)
  • Control blood pressure to <140/90 mmHg using appropriate antihypertensive agents 1 (Evidence: Strong)
  • Maintain LDL-cholesterol levels <1.8 mmol/l with statin therapy 1 (Evidence: Strong)
  • Recommend smoking cessation for all patients 1 (Evidence: Expert opinion)
  • Achieve good glycemic control in diabetic patients 1 (Evidence: Moderate)

    • References

    1 Gottsäter A. Pharmacological secondary prevention in patients with mesenterial artery atherosclerosis and arterial embolism. Best practice & research. Clinical gastroenterology 2017. link

    Original source

    1. [1]
      Pharmacological secondary prevention in patients with mesenterial artery atherosclerosis and arterial embolism. — Gottsäter A Best practice & research. Clinical gastroenterology (2017)
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