[Surgical treatment of chronic mesenteric ischemia]

The authors report the surgical management of 19 patients with chronic intestinal ischemia over the last ten years. There were 11 women and 8 men (mean age 59 years). Most patients (13/19) suffered from widespread generalized atheromatosis. Fifteen patients had symptoms which were mostly aspecific and insidious in onset. In 8 cases, there was previous misdiagnosis when pain was considered as peptic ulcer or cholecystitis, which explains a mean delay of 18 months between the onset of symptoms and angiographic evidence of coeliomesenteric stenosis. Four patients were asymptomatic and underwent a prophylactic splanchnic revascularization during aorto-iliac or aorto-renal surgery. Obstructive lesions were limited to one single digestive artery in 9 patients, 2 arteries in 7 patients and all 3 arteries in 3 patients. Twenty-two operations for coeliomesenteric revascularization were performed: 16 venous bypasses, 1 prosthetic bypass, 6 thrombendarterectomies, and 5 arterial reimplantations. Nine bypasses were retrograde versus 8 anterograde. A mean of 1.5 visceral arteries was revascularized per patient. Complete revascularization of all 3 splanchnic vessels was obtained in 73% of the cases. Operative mortality (30 days) was 16% (3 cases). Mean follow-up is 3 years. There was no single late mesenteric infarction. Four patients died of non-related causes (3 cardiac, 1 cerebrovascular), and 84% of the survivors are completely symptom free since the operation.