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Published on: April 8, 2021
Isolated bypass to the superior mesenteric artery for chronic mesenteric ischemia
1Department of Thoracic and Cardiovascular Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Korea.
Insights
Chronic mesenteric ischemia, often affecting two major arteries, can be treated effectively with bypass grafting to the superior mesenteric artery (SMA) alone when the celiac trunk is unsuitable. This surgical approach offers a durable solution for intestinal ischemia.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Abdominal Radiology
Background:
- Mesenteric ischemia typically manifests when two of the three primary splanchnic arteries are compromised.
- Atherosclerotic disease is a common cause of splanchnic artery obstruction.
Observation:
- A 50-year-old female patient presented with chronic mesenteric ischemia.
- The ischemia was attributed to atherosclerotic obstruction of both the celiac trunk and the superior mesenteric artery (SMA).
Findings:
- The patient underwent a retrograde bypass graft procedure, connecting the right common iliac artery to the SMA in a C-loop configuration.
- This case highlights the efficacy of SMA bypass grafting as a standalone procedure.
Implications:
- Complete revascularization is generally recommended for intestinal ischemia.
- Bypass grafting to the SMA alone can be an effective and durable treatment option when the celiac trunk is not a viable recipient vessel.
- This surgical strategy may improve outcomes for patients with complex mesenteric artery disease.
Abstract:
Mesenteric ischemic symptoms appear only when two of the three major splanchnic arteries from the abdominal aorta are involved. Recently, we encountered a case of chronic mesenteric ischemia in a 50-year-old female patient caused by atherosclerotic obstruction of the celiac trunk and superior mesenteric artery. She was treated with a retrograde bypass graft from the right common iliac artery to the superior mesenteric artery (SMA) in a C-loop configuration. Complete revascularization is recommended for treatment of intestinal ischemia. When the celiac trunk is a not suitable recipient vessel, bypass grafting to the SMA alone appears to be both an effective and durable procedure for treating intestinal ischemia.
