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Chronic intestinal ischemia: diagnosis and therapy
Insights
Surgical repair of splanchnic artery arteriosclerosis effectively relieved chronic intestinal ischemia symptoms in elderly patients. Revascularization procedures demonstrated long-term patency and symptom resolution, despite some perioperative mortality.
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.
Abstract:
Splanchnic arteriosclerosis is common among the elderly population, but intestinal angina is distinctly a rare entity. Extensive and efficient mesenteric collateral pathways make development of intestinal angina unlikely unless at least two major vessels exhibit hemodynamically important stenoses. Herein we describe the surgical management of 17 patients with chronic intestinal ischemia. The patients most commonly had postprandial pain and lost significant weight; angiography, including lateral aortography, confirmed the diagnosis. An average of 2.5 vessels in these 17 patients were arteriosclerotically involved. These 17 patients underwent 20 major splanchnic artery reconstructions altogether (average, 1.2 vessels per patient) for relief of symptomatic intestinal ischemia. Arterial reconstructions (16 bypass procedures and 4 endarterectomies) were undertaken with either autogenous saphenous vein (10 vessels) or Dacron prosthetics (6 vessels). Revascularizations involved the superior mesenteric artery (six patients), hepatic artery (three patients), splenic artery (seven patients), and inferior mesenteric artery (four patients). Five deaths occurred after operation, two early and three late, all from myocardial infarctions. All patients who survived have been relieved of their pain, and there has been no recurrence. The average length of follow-up has been 60.9 months and repeat angiography in six patients at intervals of up to 5 years has shown no evidence of revascularization occlusion.