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Published on: January 18, 2018
Open revascularization for chronic mesenteric ischemia in the endovascular era: a quaternary-center experience and
Bruno Pagnin Schmid1,2, Vinícius Adorno Gonçalves1, Lucas Marcelo Dias Freire1
1Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.
Insights
Open revascularization (OR) effectively treats chronic mesenteric ischemia (CMI), restoring patient health. A developed algorithm aids in selecting optimal treatment strategies for this condition.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Interventional Cardiology
Background:
- Chronic mesenteric ischemia (CMI) significantly impacts quality of life.
- Superior mesenteric artery (SMA) stenting is a primary treatment, but indications for open revascularization (OR) lack consensus.
Purpose of the Study:
- To report on four patients with CMI treated with OR.
- To present a management algorithm for CMI based on institutional experience and literature review.
Main Methods:
- Four patients with CMI underwent OR, with three presenting with intestinal angina and weight loss, and one receiving prophylactic revascularization.
- Surgical techniques included various bypass grafts to the SMA, utilizing PTFE and a retrograde C-loop configuration.
- A treatment algorithm was developed incorporating institutional data and literature review.
Main Results:
- All patients experienced symptom resolution and weight recovery.
- Grafts remained patent at a mean two-year follow-up.
- The C-loop configuration proved effective in OR for CMI.
Conclusions:
- Open revascularization with the C-loop configuration is a viable option for selected CMI cases.
- The developed algorithm can assist decision-making in CMI management at specialized centers.
Background:
Chronic mesenteric ischemia (CMI) is a debilitating disease with a heavy burden on quality of life. Stenting of the superior mesenteric artery (SMA) is the first option for treatment, but there is a lack of consensus defining precise indications for open revascularization (OR).
Objectives:
To describe a series of 4 patients with CMI treated with OR and to present an algorithm for the management of this condition.
Methods:
Three patients presented with typical intestinal angina and weight loss. One patient was subjected to prophylactic revascularization during open abdominal aortic aneurysm repair. Surgical techniques included: 1) Bypass from the infrarenal aorta to the SMA; 2) Bypass from an aorto-bifemoral polyester graft to the SMA; 3) Bypass from the right iliac artery to the SMA; 4) Bypass from the right graft limb of an aorto-biiliac polyester graft to the median colic artery at Riolan's arcade. PTFE was used in all surgeries. All grafts were placed in a retrograde configuration, tunneled under the left renal vein, making a smooth C-loop. A treatment algorithm was constructed based on the institution's experience and a review of recent literature.
Results:
All patients demonstrated resolution of symptoms and recovery of body weight. All grafts are patent after mean follow-up of two years.
Conclusions:
Open revascularization using the C-loop configuration is a valuable technique for CMI and may be considered in selected cases. The algorithm constructed may help decision planning in other quaternary centers.
