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Superior Mesenteric Artery Aneurysm



Related narrative: Superior Mesenteric Artery Aneurysm

Superior mesenteric artery (SMA) aneurysms represent approximately 5% of all splanchnic aneurysms. The most common etiology is infection, and streptococcal species are the most commonly isolated organisms. The SMA has the highest frequency of infectious aneurysms of all muscular arteries. Steptococcal infections are usually associated with left-sided endocarditis; staphyloccocal infections are associated with non-cardiac septicemia.

SMA aneurysms are most frequently isolated to the first 5 cm of the SMA but may be located in any segment adjacent to a bifurcation. Symptoms are often vague but may become severe as a result of aneurysm expansion or mesenteric ischemia. Repair is considered mandatory because of the potential for rupture or occlusion with intestinal infarction. However, the exact risks of these complications remain unknown.

Because of the risk of infection, open repair with exclusion and evacuation of the aneurysm contents is considered to be optimal treatment. Ligation of feeding vessels is most easily accomplished from within the aneurysm sac. Bowel viability must be ascertained intraoperatively using clinical inspection and noninvasive tests. Following exclusion, proximal SMA aneurysms often require bypass, but more distal aneurysms usually have adequate collaterals to support intestinal flow without bypass. Treatment of SMA aneurysms using catheter-based techniques is limited by the aneurysm location, the risk of infection, and the need to assess bowel viability.


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This page was last modified on 17-Jan-2001.