A Case of Successful Hybrid Treatment of Dual Arterial Bypass Using Indocyanine Green Fluorescence Angiography and Endovascular Treatment for Recurrent Superior Mesenteric Artery Aneurysm.

A 54-year-old woman with a mycotic superior mesenteric artery (SMA) aneurysm underwent emergent aneurysm resection with a great saphenous vein bypass. Follow-up computed tomography revealed a rapidly growing recurrent SMA aneurysm at the stump. Under the diagnosis of recurrent pseudoaneurysm of SMA with a fragile stump, we performed an open dual arterial bypass using indocyanine green fluorescence angiography and endovascular coil embolization. Subsequently, the patient's recurrent mycotic SMA aneurysm was successfully managed without mesenteric ischemic complications. This method may help prevent fatal mesenteric ischemia during SMA aneurysm surgery.

Ruptured Mycotic Aneurysm of the Superior Mesenteric Artery: A Case Report.

An infected (mycotic) aneurysm of the visceral arteries is an uncommon entity, which may arise from a secondary infection of a preexisting aneurysm or be due to degeneration from a primary infection. Mycotic aneurysms require prompt recognition and definitive treatment; otherwise, there can be devastating morbidity and mortality. We present the case of a 51-year-old female with HIV and Crohn's disease who presented with subacute abdominal pain, nausea, and vomiting and was found to have an ultimately fatal mycotic aneurysm of the superior mesenteric artery. In addition, we discuss the characteristic imaging features of mycotic aneurysms on computed tomography and magnetic resonance imaging.

Fenestrated endovascular aortic repair of a superior mesenteric artery aneurysm using carbon dioxide angiography and intravascular ultrasound.

Superior mesenteric artery aneurysms are rare; however, current guidelines suggest they all require repair due to the high rupture and mortality rates, and endovascular repair is an effective management strategy. Iodinated contrast traditionally used in endovascular repair can cause significant complications, including severe allergic reactions and contrast-induced nephropathy in patients with chronic renal disease. Therefore, other imaging methods should be used during endovascular procedures to reduce these risks. We describe a unique and innovative approach using carbon dioxide angiography and intravascular ultrasound during fenestrated endovascular repair of an uncommon superior mesenteric artery aneurysm in a patient with severe contrast allergies.

Rare Case of Abdominal Aortic and Multiple Visceral Aneurysms in a Pediatric Patient With PIK3CA Mutation and Vasculitis.

Abdominal aortic aneurysms (AAA) are most commonly observed in elderly male patients and are particularly rare in children. Among the pediatric population, they are usually diagnosed in the context of connective tissue disorders, genetic mutations, or vasculitis. The same is true of visceral arteries aneurysms. This case report describes the staged management of an 11-year-old patient presenting PIK3CA mutation and a 5.8 cm infrarenal AAA associated with bilateral common iliac arteries and multiple visceral aneurysms, the largest observed in the superior mesenteric artery (SMA = 3.2 cm). After careful evaluation, decision was made to first approach the most life-threatening lesion (the infrarenal AAA due to the large diameter) and the remaining aneurysms in secondary procedures, with special attention to the SMA aneurysm. The patient underwent a staged repair, with the first phase consisting of an aortobi-iliac graft with the distal anastomosis made at the left common iliac artery and right external iliac artery. The right hypogastric artery was ligated. The second procedure consisted of SMA aneurysm repair with a plication technique, as 7 branches were visualized coming off the aneurysm sac. Postoperative pathology analysis of the aortic and SMA aneurysms sac revealed vasculitis with a mixed inflammatory pattern and a COL3A1 gene heterozygote variant. He is currently in his 18th month after the last surgical intervention, receiving immunomodulatory therapy, with a planned follow-up by the interdisciplinary team to monitor the medications' side effects and the diameter of the remaining visceral aneurysms.

A mycotic aneurysm of a jejunal branch treated by aneurysmectomy without bowel resection.

Jejunal artery pseudoaneurysms are extremely rare, accounting for <1% of all visceral artery pseudoaneurysms. Fewer than 50 cases were reported in literature during the previous century. This case report describes the case of a 72-year-old man who underwent aneurysmectomy to treat a 21-mm mycotic jejunal artery pseudoaneurysm found in the setting of endocarditis. This pseudoaneurysm was treated with laparotomy, and gentle dissection of the tissues surrounding the pseudoaneurysm was performed before ligation and resection. This allowed for vascular collateral branch preservation, which, thus, avoided concomitant bowel resection. This report highlights the feasibility of this technique.

Superior mesenteric artery aneurysm endovascular repair.

Superior mesenteric artery aneurysms are rare and associated with high mortality rates in cases of rupture. Current Society for Vascular Surgery guidelines recommend treatment of all superior mesenteric artery aneurysms regardless of size. A 53-year-old woman who was admitted for abdominal pain was found with a 14-cm, ruptured superior mesenteric artery branch aneurysm. Endovascular approach was performed with microvascular plug embolization of a feeding branch and aneurysm sac exclusion with a stent graft. Four months later, the patient demonstrated a 21% regression of the aneurysm and stent patency. Thus, timely diagnosis and treatment of superior mesenteric artery aneurysms with endovascular techniques can reduce potential complications.

Giant Superior Mesenteric Artery Aneurysm Treated by Endovascular Treatment in a Very Elderly Female.

Superior mesenteric artery (SMA) aneurysms (SMAAs) are rare and account for approximately 7% of all visceral artery aneurysms. If the anatomical complexity permits and the patency of organ perfusion is allowed, then an endovascular approach is the first choice for minimally invasive procedures. We report the case of a 92-year-old female with a giant SMAA and challenging anatomy, including a short proximal sealing zone from the origin of the SMA and a short distal sealing zone from the hepatic artery bifurcation. In view of her advanced age, she was treated endovascularly with covered stents. Reintervention was required to correct a postoperative endoleak; however, a favorable outcome was achieved with endovascular therapy.

Treatment of stent rupture after endovascular treatment of superior mesenteric aneurysm with open surgery.

BACKGROUND: The progress of visceral artery aneurysms (VAAs) after the endovascular repair of artery aneurysms is often accompanies by the potential risks of stent fracture. The clinical reported cases of VAAs stent fractures with stent displacement were extremely rare but severe complication, particularly for the superior mesenteric artery aneurysm (SMAA). METHOD: We here reported a 62-year-old female patient with recurrent symptoms of SMAA 2 years after the successful endovascular repair using coil embolization and two partial overlapping stent-grafts in SMAA. The open surgery was performed instead of secondary endovascular intervention. RESULT AND CONCLUSION: The patient experienced a good recovery. As one of the complications after endovascular repair, stent fracture maybe more dangerous than SMAA itself, the stent fracture after endovascular repair treated by open surgery with satisfactory results is alternative and feasible.

A Rare Case of Dissecting Superior Mesenteric Artery Aneurysm in Granulomatosis with Polyangiitis.

An asymptomatic dissecting superior mesenteric artery (SMA) aneurysm in granulomatosis with polyangiitis (GPA), historically termed Wegener's granulomatosis, is rare. We herein describe a 68-year-old man who was diagnosed with GPA based on a high level of proteinase 3 (PR3)-antineutrophil cytoplasmic antibody (ANCA). One year after remission of GPA, the patient developed pyelonephritis, and his PR3-ANCA level increased again. Computed tomography showed a rapid increase in the size of the dissecting SMA aneurysm. The patient underwent successful endovascular stent-graft repair. At the time of this writing, 3 years had passed since the surgery and the clinical course was good.

[Superior mesenteric artery aneurysm]. / Anevrizma verkhnei bryzheechnoi arterii.

We report surgical treatment of 4 patients with superior mesenteric artery aneurysm. A comprehensive examination including Doppler ultrasound and CT angiography of visceral arteries made it possible to assess the features of vascular anatomy. In accordance with the peculiarities of upper mesenteric artery angioarchitectonics, open and endovascular methods were used. A differentiated approach made it possible to treat patients without any complications.

Aneurysms of the superior mesenteric artery and its branches.

OBJECTIVE: Aneurysms of the superior mesenteric artery (SMA) and its branches are rare and account for only 6% to 15% of all visceral artery aneurysms. In the present report, we have described our 30-year experience with the management of aneurysms of the SMA and its branches at a high-volume referral center. METHODS: A retrospective review of all patients with a diagnosis of an aneurysm of the SMA or one of its branches from 1988 to 2018 was performed. Pseudoaneurysms and mycotic aneurysms were excluded. The clinical presentation, etiology, aneurysm shape and size, treatment modalities, and outcomes were analyzed. The growth rate of the aneurysms was estimated using linear regression. RESULTS: A total of 131 patients with 144 aneurysms were reviewed. The patients were primarily men (64%), with a median age of 60 years. Of the 144 aneurysms, 57 were fusiform, 30 were saccular, and 57 were dissection-associated aneurysms. Of the 131 patients, 41 had had an isolated SMA branch aneurysm. Degenerative aneurysms were the most common etiology (66%). A total of 35 patients (27%) were symptomatic at presentation. Of the 144 aneurysms, 111 had multiple computed tomography angiograms available, with a median follow-up of 43.6 months (interquartile range, 10.6-87.2 months). Only 18 aneurysms (16%) had had an estimated growth rate of ≥1.0 mm/y. The initial aneurysm size was significantly associated with the growth rate for the fusiform aneurysms (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.0-1.3]; P = .02) but not for the saccular (OR, 0.91; 95% CI, 0.76-1.1; P = 1.1) or dissection-associated (OR, 1.2; 95% CI, 0.91-1.5; P = .20) aneurysms. Acute abdominal pain (OR, 5.9; 95% CI, 1.6-22; P = .01) and chronic abdominal pain (OR, 3.7; 95% CI, 1.1-13; P = .04) were associated with aneurysm growth. Only two patients had a ruptured aneurysm, both of whom presented with rupture with no prior imaging studies. These two patients had a diagnosis of fibromuscular dysplasia and systemic lupus erythematosus, respectively. Of the 131 patients, 46 (34%) had undergone operative repair, including 36 open revascularizations and 8 endovascular procedures. The average aneurysm size for these 46 patients was 24.0 ± 8.6 mm. One patient died perioperatively, and nine patients experienced perioperative complications (25%). Of the 144 aneurysms, 91 were <20 mm, with an average size of 13.4 ± 3.1 mm. These 91 aneurysms had been followed up for a median of 120.8 months (interquartile range, 30.5-232.2 months), with no ruptures within this cohort during the follow-up period. CONCLUSIONS: The present study represents one of the largest series on aneurysms of the SMA and its branches. Our results showed that aneurysms of the SMA are relatively stable. Patients with symptomatic and fusiform aneurysms had a greater risk of growth. Aneurysms <20 mm with a degenerative etiology can be safely monitored without treatment.

Anastomotic stenosis of a reconstructed dissecting superior mesenteric artery aneurysm undetectable by intraoperative indocyanine green angiography: A case report.

Intraoperative evaluation of blood flow using ICG angiography revealed no significant abnormality. However, the anastomotic stenosis was revealed by postoperative CT angiography; more precise intraoperative evaluation methods need to be developed.

Use of Indocyanine Green During Repair of a Superior Mesenteric Artery Aneurysm.

Superior mesenteric artery (SMA) aneurysms are rare and associated with a high risk of rupture, with resultant significant morbidity and mortality. During open operative repair of a superior mesenteric artery aneurysm, perfusion of the involved small bowel must be evaluated when determining need for and/or extent of vascular reconstruction. We present a case of a 51-year-old woman who underwent open repair of a non-ruptured superior mesenteric artery aneurysm with ligation and excision, in whom no revascularization was determined to be needed and the involved small bowel was able to be preserved, with intraoperative evaluation of perfusion using indocyanine green (ICG) fluorescence imaging, as an adjunct to more traditional methods of perfusion assessment.

Experience of managing superior mesenteric artery aneurysm and its midterm follow-up results with 18 cases.

OBJECTIVES: To characterize the clinical features, treatment, and prognosis of superior mesenteric artery aneurysms and provide evidence for clinical decision-making. METHODS: We retrospectively reviewed the diagnosis and treatment of 18 cases of superior mesenteric artery aneurysm admitted to our center from 2003 to 2020, including demographic data, risk factors, clinical manifestations, diagnosis, treatment strategies, and follow-up results. RESULTS: The average age of the patients was 49.1 years, and males accounted 83.3%. The development of the disease was associated with infection, hypertension, pancreatitis, and trauma, but no significant associations with atherosclerosis were noted by our results. Nine patients were diagnosed with true aneurysm, seven patients with pseudoaneurysm, and two patients with dissecting aneurysm. Rupture of aneurysm occurred in three patients (16.7%), and one of them died before surgery. The surgery success rate was 94.1%, and open surgery was performed on nine patients, endovascular surgery on three patients, and conservative treatment on three patients. The follow-up rate was 77.8% (14/18), and the average follow-up time was 48.2 months. The mortality and reintervention rate during follow-up was 0. The two-year patency rate of artificial vessels and covered stents was 50%. CONCLUSION: The clinical manifestations and features of superior mesenteric artery aneurysms vary between patients. Careful evaluation of vascular anatomy and personalized treatment strategy are critical in the management of superior mesenteric artery aneurysms. Midterm follow-up results of superior mesenteric artery aneurysms are satisfactory.

Open reconstruction of multiple huge superior mesenteric artery aneurysms.

Open reconstruction of superior mesenteric artery aneurysms is very difficult, especially if the lesion is extensive. Aneurysmal lesions were found in a 74-year-old woman during a medical checkup. Computed tomography scan showed a 6.8-cm aneurysm arising 4 cm distal to the superior mesenteric artery origin, in succession to a 2.7-cm aneurysm, and further distal small aneurysms with string-of-beads appearance. The first, second, and third jejunoileal arteries, the middle colic artery, and the ileocolic artery were originated from the aneurysms. Open reconstruction was done using a branched saphenous vein graft. Computed tomography scan confirmed the patency of the grafts. She had no major troubles for another 4 years.

Precise breakpoint detection in a patient with 9p- syndrome.

We present a case of 9p- syndrome with a complex chromosomal event originally characterized by the classical karyotype approach as 46,XX,der(9)t(9;13)(p23;q13). We used advanced technologies (Bionano Genomics genome imaging and 10× Genomics sequencing) to characterize the location of the translocation and accompanying deletion on Chromosome 9 and duplication on Chromosome 13 with single-nucleotide breakpoint resolution. The translocation breakpoint was at Chr 9:190938 and Chr 13:50850492, the deletion at Chr 9:1-190938, and the duplication at Chr 13:50850492-114364328. We identified genes in the deletion and duplication regions that are known to be associated with this patient's phenotype (e.g., ZIC2 in dysmorphic facial features, FOXD4 in developmental delay, RNASEH2B in developmental delay, and PCDH9 in autism). Our results indicate that clinical genomic assessment of individuals with complex karyotypes can be refined to a single-base-pair resolution when utilizing Bionano and 10× Genomics sequencing. With the 10× Genomics data, we were also able to characterize other variation (e.g., loss of function) throughout the remainder of the patient's genome. Overall, the Bionano and 10× technologies complemented each other and provided important insight into our patient with 9p- syndrome. Altogether, these results indicate that newer technologies can identify precise genomic variants associated with unique patient phenotypes that permit discovery of novel genotype-phenotype correlations and therapeutic strategies.

Successful Repair of Superior Mesenteric Artery Aneurysm with Reconstruction of Branches.

Superior mesenteric artery aneurysms (SMAAs) are rare and potentially life-threatening. Whether surgical or endovascular repair is performed, mesenteric ischemic complication is the greatest concern. A 56-year-old gentleman with SMAA underwent surgical resection with reconstruction of the superior mesenteric artery (SMA) and its branches using the great saphenous vein with several techniques, including island reconstruction of the branches, staged segmental cross-clamping, and an external shunt, to reduce the mesenteric ischemia time. The postoperative course was uneventful with no signs of mesenteric ischemia. A computed tomography scan showed that all grafts to the SMA and its branches were patent.

Congenital superior mesenteric artery aneurysm in a 6-week-old infant presenting with upper gastrointestinal bleeding.

Visceral artery aneurysms are rare in infants and children. The majority of cases are caused by genetic syndromes, trauma, or infection. Although the majority of aneurysms are asymptomatic, visceral artery aneurysms can present with abdominal pain, nausea/vomiting, or rupture. Aneurysm rupture can manifest as hemodynamic instability and/or gastrointestinal bleeding. We present the case of a congenital idiopathic aneurysm of the superior mesenteric artery in a 6-week-old infant who presented with gastrointestinal bleeding. We report a stepwise surgical approach to achieving aneurysm exclusion and thrombosis, and highlight the robust mesenteric collateral circulation that can develop in pediatric patients.

Open Surgical Repair Using the Femoral Vein for a Mycotic Superior Mesenteric Artery Aneurysm.

Superior mesenteric artery (SMA) aneurysms are rare and often fatal. A 72-year-old man had previously been admitted to the emergency room with epigastric pain and heart murmur. The echocardiographic diagnosis was vegetation on the aortic and mitral valves, with moderate regurgitation from both valves due to infective endocarditis. No aneurysm was detected on abdominal computed tomography, and emergency double-valve replacement was performed. On postoperative day 25, the patient experienced abrupt abdominal pain, and computed tomography revealed a mycotic SMA aneurysm. Open surgical repair of the SMA aneurysm was performed using the femoral vein, and the patient's postoperative course was uneventful.

A rare case of non-traumatic acute intraabdominal hemorrhage: ruptured superior mesenteric artery aneurysm.

INTRODUCTION: Rupture of superior mesenteric artery aneurysm (SMAA) is a very rare and life-threatening condition, presenting with acute intraabdominal hemorrhage. CASE: The patient was hospitalized upon complaint of nonspecific severe abdominal pain. Diagnosis of SMAA was established by abdominal Doppler ultrasound that showed a pseudo-aneurysmal lesion with size of 76 × 47 mm at the superior mesenteric main branch. Endovascular stenting was not performed because of the wide neck in the segment of the jejunal branches from SMA and the risk of branch loss during treatment. On the second day of hospitalization, the patient developed an acute abdomen. At explorative laparotomy for intraabdominal bleeding, the root of superior mesenteric artery was immediately and temporarily clamped to provide bleeding control. Aneurysmal tissue was resected and affected part was repaired by Dacron prosthetic graft to maintain proximal and distal vascular continuum. Intestinal viability was preserved. The patient survived disease-free as verified by his 18-month postoperative physical examination. CONCLUSIONS: The patient presents a very rare case showing ability to perform emergent intestine-sparing vascular surgery in ruptured SMAA. Surgery or endovascular treatment options should not be delayed especially in pseudo-aneurysms. It is critical to include ruptured SMAA in differential diagnosis of intraabdominal bleeding.