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Durability of antegrade synthetic aortomesenteric bypass for chronic mesenteric ischemia
Jesus G Jimenez1, Thomas S Huber, C Keith Ozaki
1Division of Vascular Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
Insights
Antegrade synthetic aortomesenteric bypass effectively treats chronic mesenteric ischemia (CMI), providing significant symptom relief and good long-term graft patency. This surgical approach offers a viable solution for patients suffering from CMI.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Optimal treatment for chronic mesenteric ischemia (CMI) remains debated, encompassing endovascular/open repair, conduit choice, and configuration.
- Antegrade synthetic aortomesenteric bypass is a surgical option for CMI, but its outcomes require comprehensive review.
Purpose of the Study:
- To review the functional outcomes, graft patency, and survival rates of patients with CMI treated with antegrade synthetic aortomesenteric bypass.
Main Methods:
- Retrospective review of patients with CMI undergoing antegrade synthetic aortomesenteric bypass from January 1987 to January 2001.
- Outcome measures included symptom relief, weight gain, graft patency (duplex ultrasound/angiography), and survival rates analyzed with life-table analysis.
Main Results:
- Forty-seven patients with CMI underwent the procedure, with 98% experiencing abdominal pain relief and 86% gaining weight at follow-up.
- Five-year graft patency rates were 69% (primary), 94% (primary assisted), and 100% (secondary), with a 5-year survival rate of 74%.
- In-hospital mortality was 11%; common complications included diarrhea and graft failure requiring revision.
Conclusions:
- Antegrade synthetic aortomesenteric bypass is associated with favorable functional outcomes for CMI patients.
- The procedure demonstrates good long-term graft patency and survival rates, supporting its role in CMI management.
Objective:
The optimal treatment (endovascular/open repair, conduit, configuration) for chronic mesenteric ischemia (CMI) remains unresolved. This study was designed to review the outcome of patients with CMI treated with antegrade synthetic aortomesenteric bypass.
Methods:
The study was designed as a retrospective review in an academic tertiary care medical center. Patients with CMI who underwent antegrade synthetic aortomesenteric bypass were identified from a computerized vascular registry (from January 1987 to January 2001) with antegrade synthetic aortomesenteric bypass as intervention. Outcome measures were functional outcome (symptom relief, weight gain) and both graft patency (duplex ultrasound/angiography) and survival rates as determined with life-table analysis.
Results:
Forty-seven patients (female, 70%; age, 62 +/- 12 years) underwent aortomesenteric bypass (aortoceliac/aortosuperior mesenteric, n = 45; aortosuperior mesenteric, n = 2) for CMI (abdominal pain, 98%; weight loss, 83%). In-hospital mortality rate was 11% (four multiple organ dysfunction, one bowel infarction), mean length of stay was 32 +/- 30 days, three patients (6%) were discharged to a nursing home, and one (2%) was discharged home on parenteral nutrition (duration 4 months). At a mean follow-up period of 31 +/- 27 months, all patients had relief of abdominal pain and 86% had gained weight (at > or =1 year follow-up: mean ideal body weight 103 +/- 22%; versus before surgery: 87 +/- 17%; P <.001). Fourteen patients (34%) had diarrhea at discharge that persisted more than 6 months in 10. One patient had acute mesenteric ischemia develop from a failed graft (at 20 months), two patients had recurrent CMI develop from failing grafts (at 46 months and 49 months), and one asymptomatic patient was found to have a failing graft with duplex ultrasound scan (at 17 months); all grafts were revised. Primary, primary assisted, and secondary 5-year graft patency rates with life-table analysis were 69% (standard error [SE], 17%), 94% (SE, 7%), and 100%, respectively, and the 5-year survival rate was 74% (SE, 12%).
Conclusion:
Antegrade synthetic aortomesenteric bypass for CMI is associated with good functional outcome and long-term graft patency.