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Mesenteric bypass for chronic mesenteric ischaemia
Y G Wolf1, A Verstandig, T Sasson
1Department of Vascular Surgery, Hadassah University Hospital, Jerusalem, Israel.
Insights
Mesenteric bypass grafting effectively treats chronic mesenteric ischaemia, relieving abdominal angina and preventing intestinal infarction. Surgical procedures are tailored to individual patient needs for optimal outcomes.
Area of Science:
- Vascular Surgery
- Gastroenterology
Background:
- Chronic mesenteric ischaemia is an uncommon condition causing abdominal angina and risk of intestinal infarction.
- Effective treatment is necessary to manage symptoms and prevent severe complications.
Purpose of the Study:
- To evaluate the safety and efficacy of mesenteric bypass grafting for chronic mesenteric ischaemia.
- To assess outcomes in patients with visceral artery stenosis or occlusion.
Main Methods:
- Retrospective review of 12 patients with visceral artery stenosis/occlusion over 3 years.
- 10 patients underwent mesenteric bypass grafting, with variations in revascularized arteries and graft configurations.
- Procedures were sometimes combined with aortic or renal revascularization.
Main Results:
- All 10 patients survived the surgical procedure.
- At a mean follow-up of 28 months, all survivors were symptom-free.
- One late death occurred due to myocardial infarction, unrelated to the initial surgery.
Conclusions:
- Chronic mesenteric ischaemia can be treated safely and effectively with mesenteric bypass grafting.
- Individualized surgical tailoring is crucial due to varied occlusion patterns and comorbidities.
- Mesenteric bypass grafting offers a viable solution for symptom relief and prevention of infarction.
Abstract:
Chronic mesenteric ischaemia is an uncommon disease that requires treatment to relieve the symptoms of abdominal angina and to prevent intestinal infarction. Over a period of 3 years, 12 patients with visceral artery stenosis or occlusion were referred to the authors' service and 10 underwent mesenteric bypass grafting. Both the coeliac and the superior mesenteric arteries were revascularized in four patients, and the superior mesenteric artery alone in six patients, using a variety of grafts and graft configurations. This was done in conjunction with aortic graft placement in four cases and with renal bypass in three. All patients survived the procedure. At a mean follow-up of 28 months, one patient died of myocardial infarction 42 months after surgery, while all survivors are symptom-free. Chronic mesenteric ischaemia can be treated safely and effectively. The variation in the pattern of mesenteric occlusions and the frequent association with aortic and renovascular disease does not allow for a single 'best' technical solution but requires the surgical procedure to be individually tailored.