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Celiac axis, superior mesenteric artery, and inferior mesenteric artery occlusion: surgical considerations
Insights
Mesenteric artery occlusion, both acute and chronic, impacts patients undergoing abdominal aortic aneurysm surgery. Surgical intervention, particularly graft bypass, offers high survival and symptom relief rates for these complex cases.
Area of Science:
- Vascular Surgery
- Gastrointestinal Surgery
- Abdominal Aortic Aneurysm Disease
Background:
- Occlusion of major visceral arteries (celiac, superior mesenteric, inferior mesenteric) presents diagnostic and therapeutic challenges.
- Acute mesenteric artery occlusion can result from embolism or intraoperative complications, while chronic forms involve multiple vessels.
Purpose of the Study:
- To analyze the outcomes of surgical management for acute and chronic mesenteric artery occlusions in patients undergoing abdominal aortic aneurysm repair.
- To evaluate the effectiveness of different surgical techniques, including embolectomy, reattachment, and graft bypass.
Main Methods:
- Retrospective analysis of 46 patients with mesenteric artery occlusion.
- Surgical interventions included embolectomy, inferior mesenteric artery reattachment, and Dacron graft bypass.
- Assessment of patient outcomes, survival rates, and symptom relief.
Main Results:
- Acute mesenteric artery occlusion (embolic or detachment) and chronic multiple vessel occlusion were identified.
- Embolic obstruction led to acute abdomen and bowel gangrene if untreated.
- Graft bypass was preferred for chronic obstruction due to simplicity and simultaneous treatment of associated aortoiliac disease.
- Overall survival was 91%, with a 5-year survival rate of 62%.
Conclusions:
- Surgical management of mesenteric artery occlusion, especially with graft bypass, provides significant symptom relief and survival benefits.
- Associated occlusive disease and aneurysms of the distal aorta can be effectively managed concurrently.
- Despite associated comorbidities, surgical intervention leads to favorable outcomes in this patient cohort.
Abstract:
Occlusion of the celiac, superior mesenteric, and inferior mesenteric artery has been studied in 46 patients treated by operation. The condition was acute and was caused by embolic obstruction of the superior mesenteric artery in four cardiac patients and detachment of the inferior mesenteric artery in two patients during removal of infrarenal abdominal aortic aneurysms. The condition was chronic and involved two or all three of the vessels in 40 patient. Embolic obstruction caused severe abdominal pain but few physical signs early in the process,, but the picture of an acute abdomen indicating bowel gangrene developed in a few hours. Ischemia from inferior mesenteric detachment was observed at operation. Patients with chronic obstruction had abdominal pain, weight loss, and diarrhea. Patients with embolic obstruction were treated successfully by embolectomy, and patients developing intraoperative sigmoid ischemia were treated by reattachment of inferior mesenteric arteries to aortic graft. Various procedures were employed in patients with chronic multiple obstruction. However, graft bypass using Dacron tubing was preferable because of its simplicity and because the frequently (48%) associated occlusive disease and aneurysm of the distal aorta were treated at the same time. Confining operation to the abdomen significantly reduced the magnitude of operation and eliminated risks in this age group. Of the 46 patients, 91% survived and were relieved of their symptoms despite associated disease. The 5-year survival rate in this group of patients was 62%.