Successful Endovascular Embolization of a Complex Superior Mesenteric Artery Branch Aneurysm with Aberrant Anatomy

Purpose: Aneurysms of the superior mesenteric artery (SMA) and its branches are an uncommon yet serious vascular pathology. Complications include mesenteric and visceral organ ischemia, necrosis, and death. In particular, a large aneurysm of the SMA or its branches requires rapid, prompt management. This was previously managed with open surgical repair; however, with advancement of endovascular technology, the current preferred management modality of SMA aneurysms is endovascular.

Materials and Methods: We report the case of an incidental 3-cm aneurysm of the first branch of the SMA. Endovascular management of this aneurysm was complicated by the finding of an occluded coeliac axis as well as aberrant mesenteric vascular anatomy with retrograde splenic arterial supply and hepatic arterial supply via the SMA. We attempted embolization of this aneurysm on multiple occasions.

Results: This aneurysm was managed successfully with endovascular embolization using a specific series of coils. We will share images and details of the series of coils and methods used for successful endovascular embolization of this complex vascular anomaly.

Conclusions: We have demonstrated that endovascular embolization remains a viable management modality of complex SMA aneurysms in individuals with atypical mesenteric arterial anatomy, and this has significant relevance in the management of these vascular entities.