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Published on: May 18, 2018
Surgical revascularization for chronic intestinal ischemia
P Zerbib1, A Khoury-Helou, G Lebuffe
1Department of General and Vascular Surgery, University Hospital of Lille, Lille, France. p-zerbib@chru-lille.fr
Insights
Surgical revascularization offers good long-term outcomes for chronic intestinal ischemia (CII). This study shows high patency and clinical success rates for bypass grafting procedures in patients with celiac artery and superior mesenteric artery disease.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Abdominal Imaging
Background:
- Chronic intestinal ischemia (CII) significantly impacts patient quality of life.
- Surgical revascularization is a key treatment modality for advanced CII.
- Accurate diagnosis and appropriate surgical planning are crucial for successful outcomes.
Purpose of the Study:
- To evaluate the long-term outcomes of surgical revascularization in patients with chronic intestinal ischemia.
- To assess the efficacy of different surgical techniques for CII.
- To correlate disease extent with treatment strategy and outcomes.
Main Methods:
- Retrospective review of 34 patients undergoing revascularization for CII between 1980 and 2003.
- Diagnosis confirmed by clinical presentation, arteriography, and angio-magnetic resonance imaging (MRI).
- Revascularization patency monitored using arteriography, color duplex ultrasound scanning (CDS), computed tomography (CT)-scanning, and angio-MRI.
Main Results:
- High rates of severe disease in the celiac artery (CA) and superior mesenteric artery (SMA).
- Successful revascularization achieved with bypass grafting (simple or double) and reimplantation techniques.
- Primary revascularization patency was 94% at 1 month and 79.4% at 4 years, with clinical success rates of 85% and 70% respectively.
Conclusions:
- Surgical revascularization is effective for managing chronic intestinal ischemia.
- Distinguishing between isolated SMA disease and multi-vessel involvement (CA and SMA) guides intervention choice.
- Double bypass grafting for CA and SMA disease offers favorable long-term patency and clinical success.
Aim:
The aim of this study was to assess outcome after surgical revascularization for chronic intestinal ischemia (CII).
Methods:
From 1980 until 2003, 34 patients underwent revascularization for CII. Records were reviewed for operative technique, perioperative mortality and long-term outcomes. CII was diagnosed on the basis of clinical, arteriographic and angio-magnetic resonance imaging (MRI) criteria. Revascularization patency was monitored by arteriography, color duplex ultrasound scanning (CDS), computed tomography (CT)-scanning or angio-MRI.
Results:
The celiac artery (CA) was severely diseased in 26 cases and the superior mesenteric artery (SMA) in 30 cases. Four patients presented single-vessel, 15 patients two-vessel, and 15 three-vessel involvement. Revascularization was performed by either simple (N=15) or double (N=19) bypass grafting. In 2 patients bypass grafting was combined with reimplantation. One patient underwent reimplantation alone. Median follow-up was 45 months. The 30-day mortality rate was 3%; there were 22 late death (64%). Primary revascularization patency was 94% at 1 month and 79.4% at 4 years. Clinical success rates were 85% and 70% respectively at 1 month and at 4 years.
Conclusion:
To choose the most suitable intervention, the Authors distinguished isolated CII treatable by single SMA revascularization from the digestive arteritis affecting the supramesocolic level of the abdomen, which requires double CA and SMA revascularization.
