Long-Term Patency and Clinical Outcomes After Retrograde Mesenteric Bypass for Chronic Mesenteric Ischemia

Chronic mesenteric ischemia (CMI) is an uncommon yet clinically significant condition resulting from insufficient blood flow to the gastrointestinal tract, frequently leading to severe symptoms and increased morbidity. Although endovascular therapy has become the initial treatment strategy in many centres, open surgical reconstruction remains an important option for selected patients. This study evaluated long-term graft patency and clinical outcomes after retrograde mesenteric bypass.

We evaluated 34 patients treated with retrograde mesenteric bypass for CMI between 2009 and 2024. Patency rates were measured with Kaplan-Meier analysis. Thrombosis was classified as early (≤30 days), mid-term (31-365 days), or late (>365 days).

Superior mesenteric artery bypass was performed in 33 patients (97.1%), celiac bypass in 25 (73.5%), and dual-vessel reconstruction in 24 (70.6%). Median follow-up was 2737 days (IQR, 1760-4353), approximately 7.5 years. No early thrombosis occurred. Two mid-term and three late occlusions were observed. Primary patency rates were 93.3% at 1 and 3 years, 89.4% at 5 years, and 85.0% at 10 years. Clinical symptoms resolved after revascularisation in all patients surviving the perioperative period, and no recurrent symptoms were documented during follow-up. No patient required reintervention.

Retrograde mesenteric bypass was associated with stable long-term patency, sustained symptom resolution, and low perioperative mortality. It remains a durable open surgical option for chronic mesenteric ischemia, particularly when endovascular revascularisation is not feasible or is unlikely to provide durable results.