Open reconstruction of multiple huge superior mesenteric artery aneurysms

Abstract

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.

Keywords: Open repair; Saphenous vein graft; Splanchnic artery aneurysm; Superior mesenteric artery aneurysm.

Fig 1

Computed tomography (CT) scan showing two fusiform aneurysms and small aneurysms with spring-of-beans appearance (SBA) in the superior mesenteric artery (SMA). ICA, Ileocolic artery; JIA, jejunoileal artery; LHA, left hepatic artery; MCA, middle colic artery.

Fig 2

Intraoperative view after the superior mesenteric artery (SMA) branches were reconstructed and schematic presentation. ICA, Ileocolic artery; JIA, jejunoileal artery.

Fig 3

Computed tomography (CT) scan on the 5th postoperative day showing patency of the branched vein graft. Arrows, the proximal and distal side of the SMA main trunk interposition graft; Open arrow, the bifurcation of the branched vein graft; Arrow heads, the anastomoses of the second, third jejunoileal arteries and the ileocolic artery; Asterisk arrow, the left colic artery.

Fig 4

Histologic specimen of the aneurysm wall showing destroyed media with disrupted elastic fibers and fibrocellular intima thickening (elastica-van Gieson stain, original magnification: right ×20, left ×100).

Fig 5

Computed tomography (CT) scan at 4 years postoperative showing development of the ascending branch of the left colic artery and the marginal artery. Arrows, the proximal and distal side of the superior mesenteric artery (SMA) main trunk interposition graft; Open arrow, the bifurcation of the branched vein graft; Arrow heads, the anastomoses of the second, third jejunoileal arteries and the ileocolic artery; Asterisk arrow, the left colic artery.