Long-term outcome after mesenteric artery reconstruction: A 37-year experience

Abstract

Although MAR for CMI carries a low mortality rate, AMI remains a lethal and frequently unheralded problem. Long-term patency and symptom-free survival can be expected after successful MAR for AMI and is comparable with those rates achieved after MAR for CMI. The patency of the SMA is important in the prevention of symptomatic recurrences. Elective MAR is indicated in patients with CMI and warrants long-term surveillance.

Acute and Chronic Mesenteric Ischemia

“…Owing to the overall rarity of mesenteric ischemia (or lack of difference between the two techniques), no studies were able to document differences in patency rates between antegrade and retrograde bypass. Although few studies report results of bypass for acute and chronic mesenteric ischemia, patency results following intervention for both disease forms are similar [52,53].…”

“…For this reason, revascularization of both vessels is encouraged if flow through both is impaired. Other studies, although not necessarily following objective measures of graft patency rates, document symptom-free survival rates (whether patients who are still alive remain free of symptoms) ranging from 57% to 86% at 5 years [21,22,51,52]. Owing to the overall rarity of mesenteric ischemia (or lack of difference between the two techniques), no studies were able to document differences in patency rates between antegrade and retrograde bypass.…”

“…In this technique, creation of the trap-door involves cutting three sides of a rectangle that surrounds the CA and the SMA (with one of the long sides being left intact). In a single study reviewing transaortic and local endarterectomy, local endarterectomy was associated with a higher rate of failure, and practice has shifted accordingly [52]. Fogarty catheter embolectomy remains an option if preoperative imaging definitively suggests embolic disease.…”

Diagnosis and management of splanchnic ischemia

“…In the study by Thomas et al 4.5% of patients with three-vessel CSD developed CSS and another 1.5% died of ASS after a follow-up of an average of 2.6 years [9] . In the Detroit experience, of the 23 patients with severe acute intestinal ischemia studied between 1963 and 2000, 12 (52%) patients had undetected CSS symptoms well before presentation [14] .…”

Intestinal Ischemia and Gangrene

“…Perioperative mortality ranges from 0-11% and increases to 50% in patients with acute-on-chronic symptoms [74]. Primary graft patency rates at five years ranges from 57% to 69%, and 5-year survival rates ranges from 63% to 77% [75,76]. Postoperative morbidity rates are increased with concomitant aortic replacement, renal disease, and complete revascularization while advanced age, cardiac disease, hypertension and additional occlusive diseases influence overall mortality [77].…”