Department of Vascular Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China.
J Vasc Surg. 2011 Jun;53(6):1619-24. doi: 10.1016/j.jvs.2011.02.004. Epub 2011 Apr 30.
Superior mesenteric artery (SMA) aneurysms are rare but life-threatening entities. This study summarizes our experience in providing therapeutic management for true aneurysms of the SMA.
Between February 1998 and March 2010, 10 patients were diagnosed with true SMA aneurysms in our hospital. Medical data for demographics, clinical presentation, diagnosis, aneurysm characteristics, treatment modalities, outcomes, and follow-up were retrospectively analyzed.
Ten patients (six women, four men) were enrolled with a mean age of 56.7 years (range, 42-69 years). One patient (10%) had aneurysm rupture and presented with abdominal pain, and seven (70%) were asymptomatic. The size of nonruptured aneurysms ranged from 1.2 to 8.0 cm (mean, 3.5 cm). Of 10 patients, five received endovascular stent graft repair, two were treated surgically, two were observed, and one with aneurysm rupture died of hemorrhagic shock before surgery. The two surgical patients underwent SMA reconstruction after aneurysmectomy, and segmental bowel resection was performed in one patient after reconstruction. The overall mortality rate was 10%. Postoperative gastroparesis was identified in one patient (14.3%). Mean operation time was 3.6 hours in the surgical group and 1.3 hours in the endovascular group. Mean postoperative hospital stay for the two groups was 20.0 days and 2.2 days, respectively. Mean follow-up was 30.9 months (range, 3-72 months). Endoleak was found in one patient 3 months after endovascular repair.
True SMA aneurysms are uncommon entities with definite rupture risk and mortality. Compared with surgical intervention, endovascular stent graft placement is associated with less trauma and rapid recovery. It may be a promising alternative to surgical intervention. The most appropriate treatment depends on the characteristics of the lesion and the condition of the patient.
肠系膜上动脉（SMA）动脉瘤较为罕见，但具有致命风险。本研究总结了我们在治疗 SMA 真性动脉瘤方面的经验。
1998 年 2 月至 2010 年 3 月，我院共诊断出 10 例 SMA 真性动脉瘤患者。回顾性分析患者的人口统计学、临床表现、诊断、动脉瘤特征、治疗方式、结果和随访等数据。
10 例患者（6 例女性，4 例男性），平均年龄 56.7 岁（42-69 岁）。1 例（10%）患者因动脉瘤破裂而出现腹痛，7 例（70%）患者无明显症状。未破裂动脉瘤的大小为 1.2-8.0cm（平均 3.5cm）。10 例患者中，5 例行血管内支架修复，2 例手术治疗，2 例保守观察，1 例因破裂出血性休克在术前死亡。2 例手术患者在动脉瘤切除后行 SMA 重建，1 例重建后行肠段切除。总的死亡率为 10%。术后发现 1 例（14.3%）患者存在胃轻瘫。手术组的平均手术时间为 3.6 小时，血管内组为 1.3 小时。两组患者的平均术后住院时间分别为 20.0 天和 2.2 天。平均随访时间为 30.9 个月（3-72 个月）。血管内修复后 3 个月发现 1 例患者存在内漏。
SMA 真性动脉瘤是一种罕见的疾病，具有明确的破裂风险和死亡率。与手术干预相比，血管内支架置入术创伤小、恢复快。这可能是一种有前途的手术干预替代方法。最适当的治疗方法取决于病变的特征和患者的状况。
