Superior Mesenteric Artery Aneurysm

I have a celiac and a SMA aneurysm of significant sizes that my vascular specialists choose to watch but feel there will be no need to surgically repair.

hello

61 y/o male-i have a celiac artery dissection and aneurysm that has been stable and am being monitored yearly with US doppler. would advise ensuring you are being monitored and evaluated at a tertiary care academic center where they see this condition more frequently by getting referrals as is somewhat unusual and there are different types of aneurysms too-mine is fusiform-dilated but my undertanding the saccular type is more serious.

@mjpisa
Thanks so much. Mine is saccular. We are monitoring every 6 months. I am dealing with a Dr. here in Hawaii but will go to Stanford, hopefully, should surgery be required. How long have you had yours? I’m going on a year since detection.

My aneurysm is fusiform (dilated vessel) with dissection. My diagnosis was intially missed on a routine ct scan after I had severe abdominal pain in 2017. I spent 2-3days in the hospital at that time and had an endoscopy and was assumed to have mild gastritis. I had another CT in 2023 for blood in urine and the aneurysm was detected and in retrospect was present in 2017 and stable. I suspect this was intially due to my inflamed gallbladder with some pancreatitis from gallstones in 2013. On the ct from that time there is mild inflammatory stranding around my celiac so I suspect it weakened the blood vessel. I have been stable with annual US doppler monitoring after my diagnosis in 2023. also, was treated for H. pylori which was detected on my endoscopy. it is my understanding that h. pylori infection can cause these aneurysms too especially the more saccular ones. Best wishes

Very Similar situation. 65 yo male. 4 x 5 mm. saccular aneurysm Arc of Buhler/Pancreaticoduodenal arcade in the setting of near total celiac occlusion secondary to median arcuate ligament. Will be getting an opinion at John Hopkins on April 10. It is quite rare, and I suspect that Hopkins will also be recommending surveillance.

Yes, very rare. Both Mayo Clinic and Stanford were involved. No coiling and the open surgery could be “devastating” per Stanford. Potential loss of bowel/liver function is daunting. Every 4-6 month monitoring for now. Pickleball 3 times a week keeps my head on. Keep me posted!

May I inquire as to the size of your aneurysm? Did they indicate their estimation of the annual risk for aneurysm rupture? Did they discuss how they would treat it should it rupture? Did they recommend any precautions (avoid certain activities etc.)? I know these questions are rather intrusive, but they would help my in my upcoming consultation at Hopkins. Thanks in advance!

The size is 1.9 x 2.4 sacular. I asked the hard question about how much time I would have should it rupture. It’s hours..I’m never far from a hospital. They’ve put no restrictions on activity but I don’t lift weights by choice. They (a conference of vascular surgeons) think a bypass would be the likely procedure but with one artery down (occluded celiac like you) it’s very risky and would be an open procedure. I don’t mind sharing. All info is good!

@meely
Back from Hopkins. They believe aneurysm arises from Pancreaticoduodenal arcade, and not an arc of Buhler. In my case the pancreaticoduodenal artery is a single vessel, not a pared vessel (anterior and posterior branches). If it was a paired vessel, they could simply occlude the branch with the aneurysm. This option is not available given the single collateral route. They believe risk of treating the aneurysm far outweighs benefit at this point in time. They recommended one year follow-up with re-evaluation of risk benefit ratio. They will be more concerned with rate of growth of the aneurysm as opposed to absolute size. They did not recommend any precautions. The most reassuring thing they told me is that a sudden catastrophic hemorrhage is very unlikely. They stated it is much more likely that the aneurysm would present with a small "sentinel bleed" (small micro-puncture which spontaneously heals itself). This would be very painful, and and send to the ER. A CT angiogram would then be obtained which would show a small perianeurysmal hemorrhage. This would then given the surgeons and interventional radiologists time to plan a treatment.
My collateral vessel is quite tortuous (see attached photo), thus treating any aneurysm via coils or exclusionary stent would be quite difficult.

Thanks for the info. The doctors I see all recommend 6 month monitoring and CT scans are better than ultrasounds. The conference(s) of doctors all believe stenting is out and open surgery would be the last/best option. Mine is calcified which may be giving it a layer of protection.