Chronic intestinal ischemia: diagnosis and therapy

Area of Science:

• Vascular Surgery
• Gastroenterology

Background:

• Splanchnic arteriosclerosis is prevalent in the elderly.
• Intestinal angina is a rare complication due to extensive collateral circulation.
• Significant stenosis in multiple major splanchnic vessels is required for intestinal angina development.

Purpose of the Study:

• To describe the surgical management of chronic intestinal ischemia caused by splanchnic arteriosclerosis.
• To evaluate the outcomes of splanchnic artery reconstructions in patients with chronic intestinal ischemia.

Main Methods:

• Retrospective review of 17 patients undergoing splanchnic artery reconstruction for chronic intestinal ischemia.
• Diagnosis confirmed by angiography, including lateral aortography.
• Surgical interventions included bypass procedures and endarterectomies using saphenous vein or Dacron grafts.
• Revascularization targeted the superior mesenteric, hepatic, splenic, and inferior mesenteric arteries.

Main Results:

• 17 patients underwent 20 splanchnic artery reconstructions.
• Average of 2.5 arteriosclerotic vessels per patient.
• 16 bypasses and 4 endarterectomies were performed.
• Postoperative mortality was 29% (5 deaths), primarily from myocardial infarction.
• All surviving patients experienced complete relief of ischemic pain with no recurrence.
• Long-term follow-up (average 60.9 months) showed no revascularization occlusion on repeat angiography.

Conclusions:

• Surgical revascularization is an effective treatment for chronic intestinal ischemia secondary to splanchnic arteriosclerosis.
• Despite perioperative risks, patients achieve durable symptom relief and improved quality of life.
• Long-term patency rates of splanchnic artery reconstructions are high.