Interventional treatment for true aneurysm of superior mesenteric artery: A systematic review of the literature on open surgical strategies

Abstract

Background

True aneurysms of the superior mesenteric artery (SMAA) are rare but clinically significant due to the risk of severe complications such as mesenteric ischemia and fatal hemorrhage upon rupture. While the European Society for Vascular Surgery (ESVS) recommends endovascular repair as the first-line treatment, open surgery remains a valuable option when endovascular repair is not feasible due to clinical or technical constraints.

Method

A systematic literature review was conducted covering the period from 2010 to 2024. Twenty-five surgically treated SMAA cases were identified. Data were collected on patient characteristics, surgical indications, procedures performed, and clinical outcomes.

Result

The majority of patients were male (80%) with a mean age of 46 years. Indications for open repair included mycotic aneurysm (48%), collagenous disease or fibrodysplasia (20%), emergency repair for hemoperitoneum (4%), and unfavorable anatomy for endovascular treatment (28%). Surgical techniques included simple aneurysmectomy (56%) and aneurysm resection with graft reconstruction (44%). No intra- or postoperative bleeding or major complications were reported. In-hospital mortality was 16%, primarily due to acute bowel ischemia (12%). Among survivors, vascular reconstructions demonstrated 100% patency at a mean follow-up of 14 months (range 1–48 months), with no need for reintervention and no deaths during follow-up.

Conclusion

Open surgical repair remains a viable treatment option in cases of infected SMAA, collagenous disease, or complex anatomy unsuitable for endovascular repair. It ensures satisfactory survival, favorable clinical outcomes, and durable mid-term patency without the need for reintervention.