Revascularization in the Treatment of Mesenteric Artery Aneurysm

Superior mesenteric artery aneurysms (SMAAs) are rare vascular lesions characterized by a high risk of rupture, associated with mortality rates between 38% and 90%. Despite their rarity, the increased use of computed tomography (CT) has led to more frequent incidental findings. SMAAs are most often of idiopathic origin, with mycotic aneurysms frequently linked to infective endocarditis. Clinical presentations vary, often including abdominal pain and gastrointestinal bleeding. Prompt diagnosis via CT angiography is crucial, given the life-threatening complications associated with ruptures. Treatment strategies must be tailored to aneurysm morphology and patient health. Endovascular treatments, such as coil embolization and stent placement, offer minimally invasive options with favorable outcomes. However, open surgical repair remains essential, particularly for mycotic aneurysms or when endovascular options are contraindicated. Hybrid approaches combining endovascular and open techniques are emerging as viable options for complex cases. Critical to all strategies is maintaining adequate mesenteric blood flow to prevent intestinal ischemia. Advances in imaging, such as indocyanine green angiography and time-resolved magnetic resonance angiography, enhance surgical decision-making, optimizing outcomes. Future treatment paradigms should focus on individualized approaches, incorporating emerging surgical techniques and enhanced imaging modalities to improve long-term survival rates.