68 - Endovascular Treatment of Infected Superior Mesenteric Artery Aneurysm: A Case Report and Systematic Review
S. K. Ramasamy, O. Ahmed
Purpose: Infected 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 due to 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.
Material and Methods: A 47 years old male complaints of right upper quadrant abdominal pain, vomiting, dyspnea, fatigue, malaise and afebrile. Antero-Posterior and sagittal 3D CT angiography demonstrated a bi-lobed irregular shaped aneurysm arising from the mid-Superior Mesenteric Artery. Angiography confirms the Superior Mesenteric Artery pseudoaneurysm. Stent-assisted coiling of the aneurysm is carried out. Iliocolic artery was selected to place stent and confirmed with angiography. ‘Zilver self-expanding stent’ (Cook Medical, Cook Medical, Bloomington, Indiana) 8mm x 60mm was first deployed. Superior Mesenteric Artery was patent with filling of aneurysm post stent placement. Through an interstice of the stent, the lower component of the aneurysm selected with a hi-flo microcatheter. The Penumbra Ruby Coils (Penumbra Inc., Alameda, California) 30cm in length were placed to fill the aneurysm. Second component of aneurysm was selected with microcatheter. 30 cm ruby coil was followed by a 60cm 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 and with maintained perfusion in Superior Mesenteric Artery branches.
Conclusions: Endovascular interventions using the insertion of stents, coils, adhesive, endovascular plugs, or thrombin, is a feasible technique for treating infected Superior Mesenteric Artery aneurysms with very high technical success rate.