Related Experiment Video
Updated: May 3, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Surgical revascularization in chronic mesenteric ischemia
R F Popa1, Cristina Strobescu1, Genoveva Baroi1
1Faculty of Medicine, University of Medicine and Pharmacy Grigore T. Popa, Iaşi.
Insights
Chronic mesenteric ischemia (CMI) can be fatal, but surgical bypass offers favorable outcomes. Open surgery for CMI demonstrates high long-term patency rates, improving patient survival and symptom remission.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Chronic mesenteric ischemia (CMI) is a serious condition often diagnosed late, primarily caused by atherosclerosis.
- Delayed diagnosis of CMI can lead to severe complications like starvation or enteromesenteric infarction.
Observation:
- Two CMI cases presented with symptoms of mesenteric and aortoiliac disease.
- CT angiography identified atherosclerotic lesions in visceral arteries and the aortoiliac system.
Findings:
- Both patients underwent successful aortobifemural bypass with aortic-superior mesenteric artery bypass.
- Surgical intervention resulted in favorable outcomes, including symptom remission and weight gain.
- Follow-up via CT angiography and Doppler ultrasound confirmed bypass patency.
Implications:
- Open surgery for CMI is a challenging yet effective treatment, achieving 90% symptom remission.
- Long-term patency rates for open surgical repair exceed 80-90% at 5 years, surpassing endovascular therapies.
- CMI management requires a multidisciplinary approach, emphasizing timely diagnosis and surgical revascularization.
Abstract:
Chronic mesenteric ischemia (CMI) is a disease causing death either by starvation or enteromesenteric infarction. Diagnosis is often delayed before the patient is referred to a vascular surgery unit. Atherosclerosis is the main cause of CMI. Arteriography is essential in diagnosing CMI and delineating the atherosclerotic lesions. The revascularization procedure consists in an aortomesenteric bypass reconstructing 1-3 visceral arteries. This paper presents two consecutive CMI cases treated at the Vascular Surgery Unit of the Iaşi "Sf Spiridon" Hospital during 2010. Both patients had symptoms suggestive of mesenteric and aortoiliac diseases. CT angiography revealed specific lesions both for aortoiliac disease and stenotic or occlusive lesions in the celiac trunk and mesenteric arteries. Both cases benefited from aortobifemural bypass surgery using a synthetic graft associated with aortic-superior mesenteric artery bypass with reversed vein graft (in the first case both mesenteric arteries were revascularized). Immediate and remote results were favorable, with remission of intestinal symptoms and weight gain. Bypass patency was followed-up by CT angiography and Doppler ultrasound. CMI is a diagnostic and therapeutic challenge. Open surgery provides symptom remission in 90% of cases. Permeability at 5 years is 80-90% for open surgery, higher than by endovascular therapy. Average permeability of the two types of intervention is 70% at 5 years, similar to the infraaortic bypasses.
