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Surgical management of chronic intestinal ischemia: a reappraisal
Insights
Complete surgical revascularization for chronic intestinal ischemia offers optimal long-term symptom relief. Revascularizing all affected visceral arteries significantly reduces symptom recurrence compared to single-vessel procedures.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Interventional Cardiology
Background:
- Chronic intestinal ischemia (CII) significantly impacts patient quality of life, presenting with abdominal pain and weight loss.
- Visceral artery occlusive disease is the primary cause of CII, often involving multiple arteries.
- Surgical revascularization is a key treatment modality for CII.
Purpose of the Study:
- To evaluate the long-term efficacy of surgical revascularization for chronic intestinal ischemia.
- To compare recurrence rates based on the extent of revascularization (single vs. multiple vessels).
Main Methods:
- Retrospective analysis of 56 patients with chronic intestinal ischemia undergoing surgical revascularization.
- Angiographic documentation of visceral artery occlusive disease.
- Assessment of symptom relief and late recurrence rates based on the number of revascularized vessels.
Main Results:
- The overall mortality rate was 8.9%.
- 96% of survivors experienced complete symptom relief.
- Complete revascularization of all stenotic vessels in cases of multiple-vessel disease resulted in an 11% late recurrence rate, significantly lower than partial revascularization (29-50%).
Conclusions:
- Complete revascularization of all stenotic visceral arteries is crucial for optimal long-term outcomes in chronic intestinal ischemia.
- While single-vessel revascularization may provide initial symptom relief, it is associated with higher recurrence rates.
- Comprehensive surgical intervention improves durability and reduces late symptom recurrence.
Abstract:
Fifty-six patients with chronic intestinal ischemia underwent surgical revascularization. All patients had abdominal pain, 98% experienced significant weight loss, and 75% had an abdominal bruit. Visceral artery occlusive disease was documented by angiography in all patients; 77% of our patients had multiple-vessel occlusive disease, and 23% had single-vessel involvement of either the celiac or the superior mesenteric artery. The mortality rate was 8.9%. Ninety-six percent of the survivors were completely relief of symptoms, but an overall late recurrence rate was noted in 26.5%. Fifty-nine percent of our patients underwent revascularization of all stenotic vessels. Complete revascularization in multiple-vessel disease resulted in a late recurrence rate of 11%. When two of three stenotic vessels were revascularized, there was a 29% recurrence rate, and when one of three stenotic vessels was revascularized, there was a 50% recurrence rate. These findings suggest that although single-vessel revascularization may relieve symptoms, the optimal long-term result can be obtained by complete revascularization of all stenotic vessels.