Superior mesenteric artery transposition for acute mesenteric ischemia

Superior mesenteric artery (SMA) transposition is a surgical technique previously described in the literature for the management of Nutcracker syndrome, SMA syndrome, and rarely their combination. However, its role in the successful treatment of acute mesenteric ischemia (AMI) remains unclear. A 55-year-old female patient presented to the emergency room of our institution with AMI and the computed tomography angiography findings of proximal SMA occlusion and bowel ischemia. After a failed attempt at retrograde open mesenteric stent procedure and ineligibility to undergo conventional surgical options for AMI, SMA transposition was performed with an end-to-side anastomosis of the SMA onto a healthy infrarenal aorta. Complete resolution of the symptoms was achieved in this case, and follow-up imaging at 6 weeks and 10 months showed a patent transposed SMA. This article describes the surgical technique for SMA transposition and highlights the novel application of this approach for AMI.