Surgical treatment of chronic mesenteric arterial insufficiency

Rheudasil, J.Mark; Stewart, Mark T.; Schellack, Jon; Smith, Robert B.; Salam, Atef A.; Perdue, Garland D.

doi:10.1016/0741-5214(88)90117-6

Cited by 110 publications

(45 citation statements)

References 12 publications

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“…Der Verschluû von mindestens 2, in der Regel jedoch aller 3 Visceralarterien fu È hrt zur klinischen Symptomatik und Diagnosestellung [11,13,24,25,28]. Isolierte Verschlu È sse der Visceralarterien (Tc, AMS, AMI) bleiben bei suffizienter Collateralisation fast immer klinisch inapparent.…”

Section: Pathophysiologieunclassified

“…Eine Indikation zur operativen Revaskularisation ist zweifelsfrei gegeben, wenn die klinische Symptomatik mit angiographisch nachgewiesenen Verschlu È ssen oder Stenosen einer oder mehrerer Viszeralarterien korreliert [11,13,14,17,24,25]. Der alleinige Verschluû der AMI ohne relevante Vera È nderung der beiden anderen Visceralgefa È ûe und der Beckenarterien verla È uft asymptomatisch und bedarf keiner Behandlung.…”

Section: Chronische Intestinale Ischa è Mieunclassified

“…der Ein-bzw. simultanen Zweigefa È ûrekonstruktion [5,11,14,24,25,29]. Fu È r die ¹Totalrekonstruktionª spricht, daû die gefu È rchtete postoperative Thrombose eines rekonstruierten Gefa È ûes bei funktionierender Collateralisation nicht zu akuten visceralen Durchblutungssto È rungen fu È hrt.…”

Section: Chronische Intestinale Ischa è Mieunclassified

“…2±6), ohne daû eine der beschriebenen Verfahren eindeutige Vorteile aufweisen kann [25]. Bei allen Rekonstruktionstechniken wird ein transperitonealer Zugang gewa È hlt (mediane Laparotomie); als Bypassmaterial wird der autologe Venenbypass (V. saphena magna) bevorzugt; als Alternative zum autologen Transplantat kommen 6 mm ultradu È nne Dacron-oder PTFE-Prothesen infrage [5,11,13,14,17,24,25]. Das am ha È ufigsten gewa È hlte Revascularisationsverfahren fu È r die AMS ist der antegrade aortoviscerale Bypass.…”

Section: Chronische Intestinale Ischa è Mieunclassified

“…Die prima È re Offenheitsrate betra Ègt nach 5 Jahren 80±90 % [11,14,15]. Die postoperative Beschwerdefreiheit bei den symptomatischen Patienten liegt zwischen 60 und 80 % [11,14,15,24,25].…”

Section: Chronische Intestinale Ischa è Mieunclassified

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Chirurgisch-technische Leitlinien bei intestinaler Ischämie

Betzler

1998

Chirurg

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Acute occlusive mesenteric ischemia is caused by a local impairment of splanchnic blood flow and poses a particular surgical challenge. Acute superior mesenteric occlusion is a medical/surgical emergency mandating prompt diagnosis (clinical awareness, angiography) and therapy (exploratory laparotomy with possible arterial reconstruction; embolectomy, thrombectomy; and/or bowel resection). The difficulty of early diagnosis is probably the most important cause of the high mortality which varies from 70% to 90% in arterial and functional mesenteric ischemia and from 20% to 70% in an acute thrombosis of the mesenteric veins. Improved survival from nonocclusive mesenteric ischemia is dependent upon the identification of high-risk groups and on aggressive diagnostic and therapeutic measures (intra-arterial infusion of papaverine through the angiographic catheter with or without bowel resection). For assessment of bowel viability, the clinical judgement during first- or second-look exploration is still the most reliable parameter. The surgical management of chronic mesenteric ischemia includes aortomesenteric grafting and transaortic endarterectomy in the majority of patients with comorbidity of cardiovascular arteriosclerotic diseases and results in a high rate of symptom-free patients. Prophylactic reconstruction of visceral arteries is indicated only in certain limited circumstances.

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Section: Pathophysiologieunclassified

Section: Chronische Intestinale Ischa è Mieunclassified

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Chirurgisch-technische Leitlinien bei intestinaler Ischämie

Betzler

1998

Chirurg

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Chronic Mesenteric Vascular Syndrome

Geelkerken

Bockel²,

Roos³

et al. 1991

Arch Surg

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Since 1961, 14 patients at the University Hospital of Leiden, the Netherlands, have undergone reconstructive surgery for treatment of chronic mesenteric vascular syndrome. Of the 42 mesenteric arteries, 31 were severely obstructed (mean, 2.2 stenotic arteries per patient). A total of 23 mesenteric arteries were repaired. Long-term follow-up data were available for all 13 surviving patients (mean follow-up, 11.8 years). Symptoms were relieved immediately after surgery, and relief was maintained during follow-up. Digital subtraction angiography at long-term follow-up evaluation was performed in eight patients (13 reconstructions) with these results: 11 (85%) of the 13 reconstructions were patent and severe stenoses were found in eight (33%) of the 24 mesenteric arteries (mean, 1.0 stenotic artery per patient). We conclude that reconstructive surgery for patients with chronic mesenteric vascular syndrome promptly relieves symptoms, provides excellent patency, and has long-lasting beneficial results.

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