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Updated: Aug 21, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Splenic artery-to-superior mesenteric artery bypass for chronic mesenteric ischemia--a case report
Dipankar Mukherjee1, Kimberly M Hendershot
1Inova Fairfax Hospital, Fairfax, VA, USA.
Insights
Chronic mesenteric ischemia (CMI) can be treated by revascularizing the superior mesenteric artery (SMA). Using the splenic artery for SMA revascularization offers advantages over traditional bypass, including fewer anastomoses and avoidance of aortic cross-clamping.
Area of Science:
- Vascular Surgery
- Gastrointestinal Surgery
- Interventional Cardiology
Background:
- Chronic mesenteric ischemia (CMI) is a serious vascular condition that can lead to bowel necrosis and high mortality if untreated.
- Current surgical treatments for CMI involve arterial bypass grafting, typically using synthetic or venous conduits with inflow from the aorta or iliac artery.
Observation:
- The splenic artery presents a viable alternative conduit for superior mesenteric artery (SMA) revascularization in select CMI cases.
- Splenic artery grafts offer potential advantages, including long-term patency similar to arterial conduits used in coronary artery bypass grafting.
- Utilizing the splenic artery simplifies the procedure by requiring only one anastomosis and avoiding aortic cross-clamping, thus reducing risks of cardiac ischemia and hypotension.
Findings:
- The splenic artery provides a natural inflow, necessitating only a single outflow anastomosis to the SMA, which decreases the risk of anastomotic stenosis.
- Avoiding aortic cross-clamping mitigates risks associated with cardiac ischemia and hemodynamic instability.
- A potential disadvantage is the risk of splenic ischemia, which may necessitate splenectomy, though collateral circulation often preserves splenic function.
Implications:
- Splenic artery revascularization is a valuable option for SMA reconstruction in CMI patients, offering a less complex arterial reconstruction.
- Careful patient selection and risk-benefit assessment are crucial when considering splenectomy versus the benefits of avoiding aortic cross-clamping.
- Timely restoration of vascular supply is key to preventing CMI progression to acute mesenteric ischemia and reducing associated mortality.
Abstract:
Chronic mesenteric ischemia (CMI) is a serious vascular condition that if left untreated may progress to acute ischemia resulting in bowel necrosis and high surgical morbidity/mortality rates. Elective intervention has been shown to prevent this progression and relieve symptoms. Current open surgical intervention involves arterial bypass using a vein or synthetic graft conduit with the inflow originating from the aorta or iliac artery. In some circumstances, the splenic artery provides an additional treatment option for revascularization of the superior mesenteric artery. In certain cases, the splenic artery has several advantages over traditional surgical options. The splenic artery is an arterial conduit much like the internal mammary artery used in coronary artery bypass grafting. These grafts are known for their long-term patency and in selected clinical circumstances are preferred over venous grafts. Because the splenic artery has a natural inflow, only a single vascular anastomosis at the outflow vessel (the SMA) is necessary. This lessens the risk of anastomotic stenosis by decreasing the number of anastomoses created and it makes the procedure shorter in duration. The fact that the inflow is provided by the splenic artery makes cross-clamping of the aorta unnecessary, thereby lessening the risk of producing cardiac ischemia and declamping hypotension. A disadvantage is the risk of splenic ischemia with the possible need for splenectomy. The majority of individuals will have adequate collateral supply to the spleen via the short gastric arteries. The risk to the patient of splenectomy versus the benefits of a less complicated arterial reconstruction with avoidance of aortic cross-clamping must be weighed on a case-by-case basis. Preventing the progression to acute mesenteric ischemia with its increased mortality by timely restoration of adequate vascular supply is an important principle in treating patients with CMI. Controversy still exists over the best treatment option for these patients, whether it be antegrade versus retrograde bypass, single-vessel versus multivessel reconstruction, or open surgical repair versus endovascular intervention. In selected patients, the use of the splenic artery can be considered as an additional option for arterial reconstruction of the SMA.
