Isolated Bypass to the Superior Mesenteric Artery for Chronic Mesenteric Ischemia

Jun, Hee Jae

doi:10.5090/kjtcs.2013.46.2.146

Cited by 4 publications

(3 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Though the long term outcome of severe multivessel disease is better with surgical revascularization, endovascular intervention has an important role in single vessel disease (19). The superior mesenteric artery is considered as the primary culprit for the symptoms (20). It was also the most involved artery in our study.…”

Section: Discussionmentioning

confidence: 72%

Coronary artery disease and mesenteric artery stenosis - Two sides of the same coin? - Long term prospective analysis

Krishnamurthy

Menon

Kannan

et al. 2019

IRDR

View full text Add to dashboard Cite

Stenosis or occlusion of the mesenteric arterial circulation is the predominant causative factor of chronic mesenteric ischemia (CMI) (1). While acute mesenteric ischemia has a dramatic presentation, CMI has an insidious course (2). The natural course of CMI is gradual with non-specific abdominal pain and unremarkable physical findings. Hence diagnosis of CMI is often delayed by months or even years (3). Atherosclerosis is the leading cause of CMI (3,4). The process of atherosclerosis is a generalized process affecting all vascular beds (such as renal artery, coronary artery, peripheral artery etc.) (5). However, variability of sequence and severity of affectation at various sites exists. Numerous studies have demonstrated asymptomatic arterial narrowing in vascular territory during evaluation of symptomatic lesions involving another region (6,7). Limited prospective data exists regarding mesenteric arterial stenosis (MAS) (5,8,9). Asymptomatic MAS Summary Coronary artery disease (CAD) patients might have concomitant mesenteric artery stenosis (MAS). Identification of risk factors predicting mesenteric artery involvement might guide screening high risk individuals. A dilemma of intervention in radiologically severe MAS exists. This prospective study included CAD patients undergoing a coronary angiogram. A concomitant mesenteric angiogram was performed to diagnose MAS. Clinically relevant MAS (CR-MAS) was defined as i) presence of classical mesenteric angina with any degree of MAS or ii) severe stenosis (> 70%) involving two or more vessels. Risk factors for CR-MAS were studied and followed up prospectively. One hundred and three patients were included in the study. Left anterior descending artery was the most common involved coronary artery and was affected in 73% (n = 76). Mesenteric angiogram revealed 42.7% (n = 44) to have MAS. CR-MAS was present in 21 patients (20.4%). Involvement of celiac axis, superior mesenteric artery and inferior mesenteric artery was 22, 39 and 15 respectively. Multivariate analysis showed mesenteric angina (p < 0.01), diabetes mellitus (p < 0.01) and peripheral artery disease (p < 0.01) to be independent predictors of CR-MAS. At a median follow-up of 36 months (range 29-48 months), there was no acute mesenteric ischemia. In patients with CR-MAS, 16 (76.2%) had symptomatic improvement and 5 (23.8%) had stable symptoms. Three patients underwent angioplasty of superior mesenteric artery for persistent symptoms. Chronic CAD patients had a high prevalence of MAS. Mesenteric angina, diabetes mellitus and peripheral artery disease are independent predictors of CR-MAS. Intervention for MAS should be dictated by symptoms and not radiological severity. Lifestyle modification and medication for atherosclerotic ischemic heart disease probably prevents acute mesenteric ischemia in CAD patients.

show abstract

Section: Discussionmentioning

confidence: 72%

Coronary artery disease and mesenteric artery stenosis - Two sides of the same coin? - Long term prospective analysis

Krishnamurthy

Menon

Kannan

et al. 2019

IRDR

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…19 During open revascularization, the literature shows good results with revascularization solely of the SMA, with long term results similar to performing grafts for more than one trunk. 20,21 Finally, the choice of treatment approach may be not so elementary as a simple issue of endovascular or open first. The decision must involve patient clinical risk stratification by a multidisciplinary team, detailed anatomic profile, individual goals of care, surgeon experience, and patient decision.…”

Section: Discussionmentioning

confidence: 99%

Open revascularization for chronic mesenteric ischemia in the endovascular era: a quaternary-center experience and management algorithm

Schmid,

Gonçalves,

Freire

et al. 2024

J. vasc. bras.

View full text Add to dashboard Cite

Background Chronic mesenteric ischemia (CMI) is a debilitating disease with a heavy burden on quality of life. Stenting of the superior mesenteric artery (SMA) is the first option for treatment, but there is a lack of consensus defining precise indications for open revascularization (OR). Objectives To describe a series of 4 patients with CMI treated with OR and to present an algorithm for the management of this condition. Methods Three patients presented with typical intestinal angina and weight loss. One patient was subjected to prophylactic revascularization during open abdominal aortic aneurysm repair. Surgical techniques included: 1) Bypass from the infrarenal aorta to the SMA; 2) Bypass from an aorto-bifemoral polyester graft to the SMA; 3) Bypass from the right iliac artery to the SMA; 4) Bypass from the right graft limb of an aorto-biiliac polyester graft to the median colic artery at Riolan’s arcade. PTFE was used in all surgeries. All grafts were placed in a retrograde configuration, tunneled under the left renal vein, making a smooth C-loop. A treatment algorithm was constructed based on the institution’s experience and a review of recent literature. Results All patients demonstrated resolution of symptoms and recovery of body weight. All grafts are patent after mean follow-up of two years. Conclusions Open revascularization using the C-loop configuration is a valuable technique for CMI and may be considered in selected cases. The algorithm constructed may help decision planning in other quaternary centers.

show abstract

Ascending Aorta to Hepatic and Mesenteric Artery Bypassing, in Patients with Chronic Mesenteric Ischemia and Extensive Aortic Disease—A Case Report and Review of the Literature

Barr

Kokotsakis

Tsipas

et al. 2017

Annals of Vascular Surgery

View full text Add to dashboard Cite

Isolated Bypass to the Superior Mesenteric Artery for Chronic Mesenteric Ischemia

Cited by 4 publications

References 16 publications

Coronary artery disease and mesenteric artery stenosis - Two sides of the same coin? - Long term prospective analysis

Coronary artery disease and mesenteric artery stenosis - Two sides of the same coin? - Long term prospective analysis

Open revascularization for chronic mesenteric ischemia in the endovascular era: a quaternary-center experience and management algorithm

Ascending Aorta to Hepatic and Mesenteric Artery Bypassing, in Patients with Chronic Mesenteric Ischemia and Extensive Aortic Disease—A Case Report and Review of the Literature

Contact Info

Product

Resources

About