Superior mesenteric artery

Dr Craig Hacking and Dr Donna D'Souza et al.

The superior mesenteric artery (SMA) is one of the three non-paired major visceral arteries in the abdominal cavity arising from the abdominal aorta and supplying the midgut.

Single vessel arising anteriorly from the abdominal aorta at the level of L1, usually just below the coeliac trunk.

Courses anteroinferiorly, behind the neck of the pancreas and splenic vein, crossing anterior to the left renal vein. It emerges anterior to the uncinate process of the pancreas and crosses anterior to the third part of the duodenum. It then enters the upper portion of the small bowel mesentery and runs along the root of the mesentery downwards to the right. Branches to the jejunum and ileum are given off to the left, and branches to the proximal and mid colon are given off to the right.

The SMA terminates at the ileum where it anastomoses with the ileal branch of the ileocolic artery. Some anatomists believe the ileocolic artery is the terminal portion of the SMA and that what many consider the terminal SMA is the last of the ileal branches.

The superior mesenteric vein (SMV) should be positioned to the right of the SMA. Reversal of SMA/SMV relationship is classically associated with intestinal malrotation, although this finding is nonspecific.

The terminal branches of SMA (ileocolic, right colic, middle colic) and inferior mesenteric artery (left colic, sigmoid) which supply the colon are linked together by a continuous arterial circle or arcade along the mesenteric border, known as the marginal artery of Drummond. This arcade is considered a normal structure, although may be absent in some people. It may supply collateral flow between SMA and IMA circulations 3. From this marginal artery, straight vessels (also known as vasa recta) pass to the colon.

The SMA is the artery to the midgut. It supplies the gut from the ampullary region of the 2nd part of the duodenum to the splenic flexure. The inferior pancreaticoduodenal artery also supplies the head of the pancreas.

Anatomy: Abdominopelvic
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Article information

rID: 5206
Section: Anatomy
Tag: cases, refs
Synonyms or Alternate Spellings:
  • Superior mesenteric artery (SMA)
  • SMA

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Cases and figures

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    Figure 1: superior mesenteric artery (Gray's illustration)
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    Case 1: coelico-mesenteric trunk
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    Figure 2: superior mesenteric angiogram annotated with branches
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    Case 2: common CA/SMA origin
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    Figure 3: branches of the abdominal aorta
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