Related Experiment Videos
Mesenteric artery bypass: objective patency determination
W D McMillan1, W J McCarthy, M R Bresticker
1Department of Surgery, McGaw Medical Center, Northwestern University Medical School, Chicago, IL, USA.
Insights
Splanchnic bypass surgery offers durable revascularization for mesenteric ischemia, achieving an 89% primary patency rate at 72 months. Objective follow-up using duplex scanning is crucial for accurate assessment of graft success.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Medical Imaging
Background:
- Symptomatic follow-up is insufficient for assessing reconstructive techniques in intestinal ischemia.
- Objective measurement of patency rates is needed for splanchnic bypass grafts.
Purpose of the Study:
- To determine primary patency rates of splanchnic bypass grafts for atherosclerotic occlusive disease.
- To evaluate objective follow-up methods like mesenteric duplex ultrasound and arteriography.
Main Methods:
- 38 splanchnic bypass grafts were placed in 25 patients with acute or chronic mesenteric ischemia.
- Graft patency was monitored using duplex scanning or arteriography.
- Life-table and log rank analysis were used to assess outcomes.
Main Results:
- The life-table primary patency rate was 89% at 72 months.
- Symptomatic follow-up had only 33% sensitivity for detecting graft occlusion.
- No significant difference in patency was found between antegrade and retrograde bypass, or between saphenous vein and polytetrafluoroethylene grafts.
Conclusions:
- Splanchnic bypass is a durable revascularization method for mesenteric ischemia.
- Objective assessment, particularly with duplex scanning, is critical for accurate patency rate measurement.
- Long-term patency for acute and chronic ischemia did not significantly differ.
Purpose:
Many authors have reported extended relief of intestinal ischemia by use of a variety of reconstructive techniques, but all have relied on symptomatic follow-up. None have objectively measured patency rates. The purpose of this study was to determine the primary patency rates of bypass grafts placed for acute and chronic splanchnic atherosclerotic occlusive disease with use of objective follow-up with mesenteric duplex ultrasound scanning or arteriography.
Methods:
Twenty-five consecutive patients (mean age 61, female/male ratio of 2.7:1) who underwent placement of 38 splanchnic bypass grafts (29 saphenous vein grafts, 9 polytetrafluoroethylene) (22 retrograde, 16 antegrade) for ischemic symptoms (9 acute ischemia: 16 chronic ischemia) between 1984 and 1994 were monitored with either duplex scanning (30 grafts) or arteriography. Life-table and log rank analysis were used to determine and compare graft patency.
Results:
Three patients (12%, 2 acute ischemia and 1 chronic ischemia) died after operation. Six patients (30%) had significant morbidity (4 acute ischemia and 2 chronic ischemia). During follow-up from 1 to 136 months (mean 35 months), no patient died of bowel infarction or required revision for recurrent symptoms. Objective testing revealed three graft occlusions. Symptomatic follow-up had a sensitivity of only 33% for graft occlusion when compared with objective measurement. The life-table primary patency rate was 89% at 72 months. Life-table survival for the same patients was 75% at 36 months. Patency rates for antegrade (93% at 36 months) versus retrograde (95% at 36 months) bypass and saphenous vein grafts (95% at 36 months) versus polytetrafluoroethylene (89% at 36 months) were not significantly different (p = 0.47 and 0.43, respectively). Late patency rates of grafts placed for acute ischemia (92% at 36 months) versus chronic ischemia (89% at 36 months) were not significantly different (p = 0.77).
Conclusion:
Splanchnic bypass for mesenteric ischemia, with a primary patency rate of 89% at 72 months, is an extremely durable form of revascularization. Long-term patency of grafts placed for acute ischemia does not differ significantly from that of bypasses for chronic occlusion. Duplex scanning allows standardized objective periodic follow-up of splanchnic reconstruction. Objective assessment is critical to accurately measure visceral revascularization patency rates.