European Journal of Vascular & Endovascular Surgery
Volume 17, Issue 1 , Pages 56-59, January 1999

Antegrade Visceral Revascularisation via a Thoracoabdominal Approach for Chronic Mesenteric Ischaemia

The Department of Surgery, Division of Vascular Surgery, The Ohio State University Hospital, Columbus, Ohio, U.S.A.

Accepted 28 July 1998.

Article Outline

Abstract 

Objectivesit has been suggested that patients with chronic visceral ischaemia are elderly and emaciated hence they may not tolerate antegrade visceral revascularisation via a thoracoabdominal approach. There are no studies to support this assumption. The purpose of this study is to assess the efficacy of this approach for the treatment of chronic visceral ischaemia.Methodsbetween 1988 and 1996, 10 patients underwent antegrade visceral revascularisation for chronic visceral ischaemia via a thoracoabdominal approach and were followed-up for a mean of 40 months. Eight patients were treated with aorto superior mesenteric artery bypass and implantation of the coeliac axis in the graft and two patients with aorto superior mesenteric bypass alone. Graft patency was monitored with duplex scanning.Resultsthere were no postoperative deaths in this series. Two patients developed postoperative pulmonary infections and required intubation for a short period of time. All patients were discharged after a mean of 17 days (range 7–38). Follow up with duplex scanning revealed that all grafts were patent. One patient developed a high grade anastomotic stenosis which was followed by recurrence of the symptoms. This was dilated on three occasions by balloon angioplasty within a period of 17 months. On the last occasion a stent was placed and since then the patient remains asymptomatic.Conclusionsantegrade visceral revascularisation via a thoracoabdominal approach is a durable and effective method of relieving symptoms of chronic visceral ischaemia. The low morbidity in this series justifies larger studies in order to establish the true incidence of complications.

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Shaw RS, Maynard EP. Acute and chronic thrombosis of mesenteric arteries associated with malabsorption: a report of two cases successfully treated by thromboendarterectomy. N Eng J Med. 1958;258:874–878
  2. Harward TRS, Brooks DL, Flynn TC, Seeger JM. Multiple organ dysfunction after mesenteric artery revascularization. J Vasc Surg. 1993;18:459–469
  3. Moneta GL, Lee RW, Yeager RA, Taylor LM, Porter JM. Mesenteric duplex scanning: a blinded prospective study. J Vasc Surg. 1993;17:779–786
  4. Zelenock G, Graham LM, Whitehouse WM. Splanchnic arteriosclerotic disease and intestinal angina. Arch Surg. 1990;115:497–501
  5. Geelkerken RH, van Bockel JH, De Ross WK, Hermans J, Terpstra JL. Chronic mesenteric vascular syndrome. Results of reconstructive surgery. Arch Surg. 1991;126:1101–1106
  6. Lande A. Abdominal Takayasu's aortitis, the middle aortic syndrome and atherosclerosis. Int Angiol. 1998;17:1–9
  7. Babu SC, Shah PM. Celiac territory ischemic syndrome in visceral artery occlusion. Am J Surg. 1993;166:227–230
  8. Rheudasil JM, Stewart MT, Schellack JV, Smith RB, Salam AA, Perdue GD. Surgical treatment of chronic mesenteric arterial insufficiency. J Vasc Surg. 1988;8:495–500
  9. Cunningham CG, Reilly LM, Rapp JM, Schneider PA, Stoney RJ. Chronic visceral ischaemia. Ann Surg. 1991;214:276–287
  10. Rob C. Surgical diseases of the celiac and mesenteric arteries. Arch Surg. 1966;93:21–30
  11. Stoney RJ, Ehrenfeld WK, Wylie EJ. Revascularization methods in chronic visceral ischaemia caused by atherosclerosis. Ann Surg. 1977;186:468–476
  12. Baur GM, Millay DJ, Taylor LM, Porter JM. Treatment of chronic visceral ischaemia. Am J Surg. 1984;148:138–144
  13. McMillan WD, McCarthy WJ, Bresticker MR, Pearce WH, Schneider JR, Golan JF, et al. Mesenteric artery bypass: Objective patency determination. J Vasc Surg. 1995;212:729–741
  14. Hollier LH, Bernatz PE, Pairolero PC, Spencer Payne W, Osmundon PJ. Surgical management of chronic intestinal ischaemia. A reapraisal. Surgery. 1981;90:946–980
  15. Moawad J, McKinsey JF, Wyble CW, Bassiony HS, Schwartz LB, Gewertz BL. Current results of surgical therapy for chronic mesenteric ischaemia. Arch Surg. 1997;132:613–619
  • f1 Please address all correspondence to: G. Geroulakos, Department of Surgery, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, U.K.

PII: S1078-5884(98)90701-8

doi:10.1053/ejvs.1998.0701

European Journal of Vascular & Endovascular Surgery
Volume 17, Issue 1 , Pages 56-59, January 1999

Article Tools