Overview
Superior mesenteric artery (SMA) aneurysms are rare vascular lesions associated with significant morbidity and mortality, particularly when complicated by rupture or thrombosis 134.Diagnosis
Clinical Presentation: Abdominal pain, gastrointestinal bleeding, and symptoms related to bowel ischemia 134.
Imaging: Computed tomography angiography (CTA) and selective interventional angiogram are crucial for diagnosis 136.
Specific Findings: CTA can reveal aneurysmal dilatation, arteriovenous fistulas, and thrombus presence 16.
Definitive Diagnosis: Doppler ultrasound followed by arteriography for definitive diagnosis, especially in branch aneurysms 4.Management
Endovascular Therapy: Feasible for treating SMA aneurysms with arteriovenous fistulas, involving aneurysm occlusion and fistula closure 1.
Surgical Repair: Recommended for symptomatic aneurysms, aneurysms ≥2 cm, and pseudoaneurysms 3.
Aortomesenteric Bypass: Used in cases where primary repair is insufficient, such as with significant collateral circulation issues 5.
Conservative Management: Considered in select cases where surgical risk outweighs benefits 2.Special Populations
Comorbidities: Hypertension, pancreatitis, and trauma are associated risk factors 2.
Elderly: Higher surgical complexity and risk; individualized assessment required 2.
Pregnancy: Not specifically addressed in abstracts; individualized risk assessment needed [Expert opinion].Key Recommendations
Intervention for Symptomatic or Large Aneurysms: Symptomatic aneurysms, those ≥2 cm, and pseudoaneurysms should be considered for intervention (Evidence: Moderate 3).
Endovascular vs Surgical Approach: Endovascular therapy is a viable alternative for selected patients, but surgical repair remains a mainstay for complex cases (Evidence: Weak 12).
Preoperative Assessment: Detailed preoperative imaging (CTA, selective angiogram) is essential for planning appropriate intervention (Evidence: Moderate 36).
Follow-Up Monitoring: Regular follow-up is crucial post-intervention to assess long-term efficacy and detect complications early (Evidence: Expert opinion).References
1 Shu X, Wang F, Tan Y. Endovascular therapy for aneurysmal dilatation and arteriovenous fistula of the superior mesenteric artery. Vascular 2026. link
2 Wang L, Shu C, Li Q, Jiang X, Li X, He H et al.. Experience of managing superior mesenteric artery aneurysm and its midterm follow-up results with 18 cases. Vascular 2021. link
3 Dasari BV, Mullan M, Lau L, Loan W, Lee B. A 6.5-cm pseudoaneurysm of the superior mesenteric artery managed by primary surgical repair. Vascular 2013. link
4 Maisonnette F, Thognon P, Durand-Fontanier S, Valleix D, Lachachi F, Descottes B. Rupture of mesenteric artery branch aneurysm. Annals of vascular surgery 2001. link
5 Chao SH, Lin FY, Chen KM. Aortomesenteric bypass using autogenous saphenous vein graft for superior mensenteric artery aneurysm: report of a case. Journal of the Formosan Medical Association = Taiwan yi zhi 1990. link
6 Passariello R, Simonetti G, Rovighi L, Ciolina A. Characteristic CT pattern of giant superior mesenteric artery aneurysms. Journal of computer assisted tomography 1980. link
7 Whitehead S. Ruptured middle colic artery aneurysm. Postgraduate medical journal 1979. link