Superior Mesenteric Artery Disorders: Current Concepts in Diagnosis and Management

ABSTRACT Background: Disorders of the superior mesenteric artery (SMA) represent a significant yet often underrecognized cause of acute and chronic abdominal pathology. Given the artery’s critical role in supplying the midgut, compromise of SMA blood flow can rapidly progress to intestinal ischemia, systemic inflammatory response, and high mortality if not diagnosed promptly. Advances in vascular imaging and endovascular techniques have substantially altered the diagnostic and therapeutic landscape in recent years. Objective: This review aims to synthesize current concepts in the diagnosis and management of SMA disorders, including acute mesenteric ischemia, chronic mesenteric ischemia, superior mesenteric artery syndrome, and isolated arterial dissection. Methods: A comprehensive narrative analysis of contemporary literature was undertaken, focusing on anatomical considerations, pathophysiological mechanisms, clinical presentation, diagnostic strategies, and evolving treatment modalities. Results: Early recognition remains the most critical determinant of outcome, particularly in acute mesenteric ischemia. Computed tomography angiography has emerged as the primary diagnostic modality due to its high sensitivity and rapid availability. Management strategies have shifted toward minimally invasive endovascular interventions, supported by timely anticoagulation and hemodynamic stabilization. In selected cases, surgical revascularization and bowel resection remain essential. For non-occlusive and compression-related conditions, individualized treatment plans incorporating nutritional, medical, or surgical approaches are required. Conclusion: Contemporary management of SMA disorders demands a multidisciplinary approach integrating rapid imaging, evidence-based pharmacotherapy, and advanced revascularization techniques. Improved awareness and standardized diagnostic algorithms are crucial for reducing morbidity and mortality associated with these vascular conditions. Keywords: Superior mesenteric artery, mesenteric ischemia, endovascular therapy, computed tomography angiography, vascular disorders