Endovascular stent--graft repair of a symptomatic superior mesenteric artery aneurysm.

Background: Aneurysms of the visceral branches of the abdominal aorta are uncommon and potential life-threatening entities. Although hepatic and splenic artery aneurysms have the highest prevalence among splanchnic aneurysms, superior mesenteric artery aneurysms are even more uncommon. For ruptured visceral arteries aneurysms, a mortality rate of between 20% and 100% has been reported. Besides rupture, the aneurysms can also erode into adjacent visceral organs, which results in severe hemorrhage. Emergency surgery of visceral artery aneurysms is related with significant mortality. In recent years, endovascular therapies have been successfully established in the elective setting. Therefore, we adopted the endovascular stent-graft insertion technique for dealing with an acute symptomatic aneurysm of the superior mesenteric artery.

Method: We report the case of a 79-year-old male patient with a symptomatic aneurysm of the proximal superior mesenteric artery. Using an endovascular approach, the aneurysm was excluded with an endoluminal stent--graft.

Result: The endoluminal stent--graft repair resulted in total exclusion of the aneurysm. Patency of the superior mesenteric artery continued and no ischemic complications occurred. Pain and other symptoms disappeared and the patient recovered entirely.

Conclusions: Endovascular management of symptomatic superior mesenteric artery aneurysm is feasible and may display excellent results in selected cases. Therefore, endoluminal stent--graft repair should be considered as an alternative to traditional surgical treatment. However, in each patient, the individual anatomy of the mesenteric circulation and the location of the aneurysm play a major role in determining whether endovascular management is possible or surgical repair should be preferred.