Indocyanine Green Fluorescence Angiography during Resection of Infectious Superior Mesenteric Artery Aneurysm with Occlusion Causing Abdominal Pain

Abstract

Mesenteric ischemia resulting from superior mesenteric artery (SMA) occlusion, an uncommon cause of abdominal pain, may require intervention. Superior mesenteric artery aneurysms (SMAAs) are rare. Resection is recommended because of their high risk of rupture and resultant significant mortality. Intraoperative assessment of perfusion of the involved small bowel is helpful when determining the need for vascular reconstruction or bowel resection; however, a standard means of assessing this has not yet been established. Here, we present a case of a 63-year-old man who presented with abdominal pain and who was found to have SMA occlusion caused by infective endocarditis, resulting in a non-ruptured SMAA. During resection of the SMAA, indocyanine green angiography to assess bowel perfusion indicated that neither revascularization nor small bowel resection were needed. His abdominal pain was resolved and his postoperative course uneventful. Indocyanine green fluorescence imaging is an effective means of assessing bowel perfusion during resection of an SMAA.