Management and Outcomes of Superior Mesenteric Artery Aneurysm Repair
Zachary H. Hodges, BS, Javairiah Fatima, MD, Salvatore T. Scali, MD, Robert J. Feezor, MD, Martin R. Back, MD, Kristina A. Giles, MD, Scott A. Berceli, MD, PhD, Michol A. Cooper, MD, George J. Arnaoutakis, MD, Thomas S. Huber, MD, PhD, Gilbert R. Upchurch, Jr., MD.
University of Florida, Gainesville, FL, USA.
Objective: Aneurysms of the superior mesenteric artery (SMAA) represent the third most frequent type of visceral artery aneurysm. The frequently mycotic nature and high rupture risk of these aneurysms support treatment upon diagnosis. In this study, we report the experience of a single institution’s management of SMAAs.
Methods: A retrospective chart review was performed to document presentation, treatment, and outcomes of patients who underwent surgical intervention for SMAA from 2003 to 2017. Primary end point was 30-day mortality. Secondary endpoints were peri-operative complications and reinterventions.
Results: Fourteen patients (53% males) with median age of 40 years (range 29-70 years) were treated at our institution for SMAA; of these 7 were noted to be mycotic. The most common symptom on presentation was abdominal pain in 11 patients, fever in 5, and nausea/vomiting in 5. One presented with a ruptured SMAA. CT was the diagnostic imaging of choice in all patients; this showed a pseudoaneurysm in 9 patients and abscess in 4. Six patients had history of IV drug abuse and presented with infective endocarditis with septic embolism. Wound and blood cultures were positive in 6 patients (2 monomicrobial and 4 polymicrobial). Of the mycotic aneurysms, 4 were repaired with saphenous vein interposition graft and 2 with ligation of the aneurysm. For non-mycotic aneuyrsm, a prosthetic graft was used for interposition in 5 patients, one underwent vein patch angioplasty, and 1 underwent ligation. One patient underwent coil embolization with SMA stent placement. Morbidity occurred in 3 patients including necrotizing pancreatitis (1), seroma (1) and renal failure/pulmonary insufficiency (1). Death occurred in 1 patient on postoperative-day 14 from multiorgan system failure. Median length of hospital stay was 24 days (range 6-48 days). At median follow-up of 7 months (range 1-183 months) patient survival rate was 85% and there were no graft related reinterventions.
Conclusion: Treatment of mycotic SMA aneurysms with autogenous interposition grafts or non-mycotic aneurysms using prosthetic grafts can be performed safely with minimal morbidity and reintervention and low mortality.
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