Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia

Abstract

Bypass grafting to the SMA alone appears to be both an effective and durable procedure for treatment of intestinal ischemia. Our results appear equal to those reported for "complete" revascularization for intestinal ischemia. When the SMA is a suitable recipient vessel, multiple bypass grafts to other splanchnic vessels are unnecessary in the treatment of intestinal ischemia.

Percutaneous Angioplasty and Stenting for Mesenteric Ischaemia

“…The simultaneous treatment of two vessels prevents symptom recurrence in the event of restenosis in either artery. Improved graft patency and survival with complete reconstruction (McAfee et al, 1992), and a higher incidence of symptoms and graft failure with single vessel therapy (Foley et al, 2000) have each been demonstrated. There is a tendency to treat fewer vessels when choosing endovascular revascularisation compared with surgical revascularisation (Kougias et al, 2009).…”

“…Literature from the surgical revascularisation setting has shown that complete revascularisation of the coeliac trunk and SMA is associated with improved long-term outcomes (Mateo et al, 1999;McAfee et al, 1992;Foley et al, 2000). The simultaneous treatment of two vessels prevents symptom recurrence in the event of restenosis in either artery.…”

Intestinal Ischemia and Gangrene

“…The indication for revascularization surgery in asymptomatic patients is not clear but it may be considered in asymptomatic patients who are submitted to aortic reconstruction for aortoiliac occlusive disease with significant mesenteric occlusion as they have an increased risk of mesenteric gangrene after surgery [72]. Often bypass grafting of the superior mesenteric artery alone instead of complete vascularization is an effective and durable procedure for treatment of intestinal ischemia [73]. For many years, surgical revascularization has been the treatment of choice for chronic mesenteric ischemia.…”

Mesenteric Vascular Disease

“…Arterial emboli are responsible for 40% to 50% of cases of AMI (2,3,4).The proximal source of the embolus is frequently intracardiac mural thrombus. Mural thrombus in proximal aneurysms in the thoracic or proximal abdominal aorta can also serve as embolic sources.…”