SMA and celiac artery aneurysm surgical treatment

Visceral artery aneurysms are rare but carry a high mortality risk when rupture occurs. The simultaneous presence of multiple aneurysms involving major visceral vessels such as the superior mesenteric artery (SMA), celiac trunk, and hepatic artery is extremely uncommon in the literature. In addition, the coexistence of a rare replaced right hepatic artery variation further complicates both diagnostic assessment and surgical/endovascular treatment planning. This case report presents the diagnostic evaluation and surgical management of a patient with concurrent aneurysms of the celiac artery, SMA, and replaced right hepatic artery.

Material and Methods: A 63-year-old woman presented with chronic abdominal pain and unintentional weight loss. During diagnostic work-up, incidental aneurysms of the celiac artery and SMA were detected, and she was referred to the cardiovascular surgery clinic. Selective celiac and SMA angiography revealed a 16 × 17 mm saccular aneurysm at the celiac trunk bifurcation involving the origin of the left gastric artery, ectatic changes of the gastroduodenal and pancreaticoduodenal branches, and a replaced right hepatic artery variant. Additional findings included a 4 mm saccular aneurysm of the replaced right hepatic artery, a 2 cm long and 10 mm wide fusiform aneurysm of the proximal SMA, and a 19 × 12 mm bilobed saccular aneurysm of the SMA ileocolic branch.Given the presence of multiple visceral artery aneurysms, a multidisciplinary team of cardiovascular surgery, interventional radiology, and general surgery decided on surgical treatment.

Results: The patient was taken to the operating theatre for surgery. The SMA and celiac arteries were dissected via median laparotomy by the general surgeon. Following systemic heparinisation, the SMA branches were clamped, an arteriotomy was performed, and the aneurysmal segment was resected with primary closure using continuous prolene sutures. Following haemostasis, the aneurysmal segment of the celiac trunk was similarly resected and repaired primarily. After confirming haemostasis, a drain was placed and the abdomen was closed anatomically. In the postoperative period, the patient remained haemodynamically stable and was monitored in the intensive care unit.

Conclusion: Multiple visceral artery aneurysms, particularly when associated with rare arterial variations, pose significant diagnostic and therapeutic challenges. This case represents a complex vascular condition rarely reported in the literature, characterized by concurrent aneurysms of the celiac artery, SMA, and replaced right hepatic artery. Early diagnosis, detailed angiographic evaluation, and multidisciplinary surgical planning are critical to reducing mortality and morbidity in such patients.

Keywords: Visceral artery aneurysm, celiac trunk, replaced right hepatic artery, vascular surgery