Endovascular Treatment of Infected Superior Mesenteric Artery Aneurysm: A Case Report and Systematic Review

Purpose: Superior mesenteric artery (SMA) aneurysms that have been infected are a very rare occurrence. The management of such aneurysms is based on existing cases in the literature and medical expertise because of a lack of randomized studies. However, the role of interventional radiology in the management of infected aneurysms is increasingly important as endovascular methods become more widely used.

Materials and Methods: A 47-year-old man complained of right upper quadrant abdominal pain, vomiting, dyspnea, fatigue, and malaise; he was afebrile. Anteroposterior and sagittal 3D computed tomography angiography demonstrated a bilobed irregular-shaped aneurysm arising from the mid-SMA. Angiography confirmed the SMA pseudoaneurysm. Stent-assisted coiling of the aneurysm was carried out. The ileocolic artery was selected to place a stent and was confirmed with angiography. An 8- × 60-mm Zilver self-expanding stent (Cook Medical) was first deployed. The SMA was patent with filling of the aneurysm after stent placement. Through an interstice of the stent, the lower component of the aneurysm was selected with a high-flow microcatheter. Penumbra Ruby Coils, 30 cm in length, were placed to fill the aneurysm. The second component of the aneurysm was selected with a microcatheter. A 30-cm Ruby coil was followed by a 60-cm packing coil. A literature review using MEDLINE with all relevant reports on “Endovascular treatment of infected superior mesenteric artery aneurysm” are included.

Results: Aneurysm was excluded with maintained perfusion in the SMA branches.

Conclusions: Endovascular intervention using the insertion of stents, coils, adhesive, endovascular plugs, or thrombin is a feasible technique for treating infected SMA aneurysms with a very high technical success rate.