Surgical repair of a middle colic artery aneurysm in a patient with occlusive mesenteric arterial disease.

Colic artery aneurysms (CAA) are among the rarest visceral artery aneurysms that carry a significant risk of rupture with a high mortality rate. Concomitant occlusive disease of the mesenteric arteries can significantly alter the type of treatment undertaken (open or endovascular). We present the case of a 68-year-old woman with a visceral artery aneurysm that was discovered coincidently during a routine ultrasound examination. The patient reported no abdominal or back pain or any symptoms associated with mesenteric ischemia. Computed tomography angiography showed a near total occlusion of the celiac trunk, segmental complete occlusion of the superior mesenteric artery, and a middle colic artery (MCA) aneurysm measuring 22 mm in diameter. Complete resection of the MCA aneurysm was performed, with subsequent reconstruction by end-to-end anastomosis. There is no clear evidence to support indications for intervention according to aneurysm size in asymptomatic patients with CAA. Endovascular occlusion of the proximal and distal arterial segments is often considered a first-line approach, which was inappropriate in our case. Open surgical reconstruction was mandatory to preserve collateral circulation and avoid bowel ischemia in circumstances of occlusive mesenteric artery disease. We decided not to treat the stenotic lesions of the mesenteric arteries, given the absence of mesenteric ischemia symptoms.