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Long-term patency of open revascularization for visceral artery pathologies
B Dorweiler1, A Neufang, J Schneider
1Department of Cardiothoracic & Vascular Surgery, University Medical Center, Mainz, Germany. dorweiler@htg.klinik.uni-mainz.de
Insights
Bypass grafting for visceral artery disease is a successful and durable procedure, despite increased perioperative mortality. Long-term patency rates were favorable in this study of visceral artery bypass grafts.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Cardiovascular Medicine
Background:
- Visceral artery diseases, including occlusive and aneurysmal conditions, pose significant challenges in vascular surgery.
- Effective revascularization strategies are crucial for managing these complex pathologies.
Purpose of the Study:
- To evaluate the long-term patency of bypass grafts utilized in the treatment of occlusive and aneurysmal visceral artery diseases.
- To assess survival and freedom from reintervention as secondary endpoints.
Main Methods:
- Retrospective analysis of 30 patients undergoing 32 operations for visceral artery pathology (January 1995 - December 2009).
- Patient cohort included acute mesenteric ischemia (aMI), chronic mesenteric ischemia (cMI), and visceral artery aneurysm (VAn).
- Primary endpoint: vessel patency; Secondary endpoints: survival and freedom from reintervention.
Main Results:
- 46 vessels were revascularized, with 26 bypass grafts used.
- Perioperative mortality was 50% for aMI and 7% for cMI.
- At 55-month follow-up, 3 out of 26 bypass grafts occluded, indicating durable patency.
Conclusions:
- Bypass grafting for visceral artery pathology is a successful and durable procedure.
- While perioperative mortality is a consideration, long-term outcomes support the efficacy of bypass grafting.
Objective:
Aim of the study was to evaluate the long-term patency of bypass grafts used to treat occlusive and aneurysmal disease of the visceral arteries.
Methods:
A retrospective analysis of our vascular surgery database identified 30 patients (11 men, mean age 59 ± 14 years) who underwent 32 operations for visceral artery pathology between January 1995 and December 2009. Acute mesenteric ischemia (aMI) was present in 10, chronic mesenteric ischemia (cMI) in 14 and visceral artery aneurysm (VAn) in 7 cases. The primary endpoint of this study was vessel patency, secondary endpoints were survival and freedom from reintervention.
Results:
A total of 46 vessels were revascularized (26 bypass grafts) and additional revascularization procedures (thromboembolectomy, patch plasty, transposition) were performed in 21 cases. In the perioperative period, 6 deaths (5 aMI, 1 cMI) occurred, resulting in a mortality rate of 50 % for aMI and 7 % for cMI. At long-term follow-up (55 months), 22 patients (100 % follow-up) were interviewed and 21 were scheduled for clinical and imaging examinations. Four vessel (3 grafts) occlusions were found in these patients.
Conclusion:
We were able to show that bypass grafting for a visceral artery pathology, although associated with an increased perioperative mortality, is a successful and durable procedure.
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