A multi-institutional study comparing antegrade and retrograde open mesenteric bypass for chronic mesenteric ischemia

Area of Science:

• Vascular Surgery
• Gastroenterology
• Surgical Outcomes Research

Background:

• Current guidelines favor endovascular therapy for chronic mesenteric ischemia (CMI), reserving open mesenteric bypass (OMB) for complex cases.
• Optimal configuration for OMB (antegrade vs. retrograde) remains debated due to differing risk profiles and patency concerns.

Purpose of the Study:

• To compare perioperative and mid-term outcomes of antegrade (AG) versus retrograde (RG) open mesenteric bypass (OMB) for chronic mesenteric ischemia (CMI).

Main Methods:

• Retrospective review of 209 CMI patients undergoing OMB at two high-volume centers (2000-2024).
• Primary endpoint: 30-day mortality. Secondary endpoints: complications, survival, and graft patency.
• Adjusted analyses included multivariable regression and propensity-matched cohorts; Kaplan-Meier methods assessed survival and patency.

Main Results:

• No significant differences in unadjusted complication rates or 30/90-day mortality between AG and RG groups.
• Excellent and comparable primary patency rates at 1 and 3 years for both configurations.
• Multivariable analysis showed bypass configuration was not independently associated with mortality or complications.
• Propensity-matched analysis revealed higher 1-year mortality after RG bypass (36.8% vs. 16.3%).

Conclusions:

• Antegrade (AG) and retrograde (RG) OMB configurations demonstrate similar perioperative morbidity and excellent graft patency in CMI patients.
• Bypass configuration is not an independent predictor of early or mid-term outcomes in adjusted analyses.
• Individualized selection of OMB configuration is supported, considering patient anatomy, comorbidities, and available resources.