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Transaortic endarterectomy for primary mesenteric revascularization
Hung Lau1, David K Chew, Anthony D Whittemore
1Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Insights
Transaortic endarterectomy offers a safe and effective solution for chronic mesenteric ischemia. This procedure successfully revascularized arteries, providing sustained symptom relief for most patients.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Surgical Innovation
Background:
- The optimal surgical strategy for chronic mesenteric ischemia (CMI) remains debated.
- Endovascular and open surgical options have limitations for primary revascularization.
Purpose of the Study:
- To evaluate the safety and efficacy of transaortic endarterectomy for primary mesenteric revascularization in CMI patients.
- To assess short-term and long-term outcomes of this surgical approach.
Main Methods:
- A descriptive retrospective analysis of 14 patients undergoing trap-door transaortic endarterectomy for CMI.
- Analysis included demographic data, perioperative details, and long-term clinical outcomes.
Main Results:
- Initial mesenteric revascularization success rate was 93% with no hospital mortality.
- Symptom relief was achieved in 93% of patients, with 1- and 3-year survival rates of 85% and 77%, respectively.
- Postoperative morbidity was 50%, with one case of late recurrent ischemia requiring bowel resection.
Conclusions:
- Transaortic endarterectomy is a safe and effective option for elective primary mesenteric revascularization in CMI.
- The technique allows for simultaneous revascularization of multiple visceral arteries, leading to durable symptom relief.
Abstract:
The optimal approach to revascularization for chronic mesenteric ischemia has not been firmly established during the past three decades. The present study was undertaken to evaluate the safety and results of primary mesenteric revascularization for chronic mesenteric ischemia by transaortic endarterectomy. A descriptive retrospective analysis of 14 patients who underwent trap-door transaortic endarterectomy for primary mesenteric revascularization was performed. Clinical presentations of the patients included abdominal pain (n=13) and weight loss (n=7). All patients underwent preoperative aortography and subsequent elective reconstruction. Demographic features, perioperative, and long-term outcomes were analyzed. The study population consisted of 12 females and two males with a mean age of 67 years. The mean operative duration was 3 hours with an ischemic time of 33 minutes. The initial success rate of mesenteric revascularization was 93%. One early graft failure was salvaged with urgent embolectomy without bowel resection. There was no hospital mortality, but the overall postoperative morbidity rate was 50% (n=7). Thirteen patients (93%) were discharged within 2 weeks. Late recurrent ischemia and intestinal infarction developed in one patient, requiring emergency bowel resection. Sustained relief of symptoms was achieved in 13 of 14 patients (93%). The overall survival rates were 85% +/-10.0% and 77% +/-11.7% at 1 and 3 years, respectively. Transaortic endarterectomy is a safe and effective technique for elective primary mesenteric revascularization for patients with chronic mesenteric ischemia. This approach allows simultaneous revascularization of multiple visceral arteries and achieves durable relief of symptoms.