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Thorac Cardiovasc Surg 2011; 59(6): 329-334
DOI: 10.1055/s-0030-1250634
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Long-Term Patency of Open Revascularization for Visceral Artery Pathologies

B. Dorweiler1 [*] , A. Neufang1 [*] , J. Schneider2 , B. Ihmels1 , E. Weigang1 , C.-F. Vahl1
  • 1Department of Cardiothoracic & Vascular Surgery, University Medical Center, Mainz, Germany
  • 2Department of Radiology, University Medical Center, Mainz, Germany
Further Information

Publication History

received July 18, 2010

Publication Date:
21 March 2011 (online)

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Abstract

Objective: Aim of the study was to evaluate the long-term patency of bypass grafts used to treat occlusive and aneurysmal disease of the visceral arteries. Methods: A retrospective analysis of our vascular surgery database identified 30 patients (11 men, mean age 59 ± 14 years) who underwent 32 operations for visceral artery pathology between January 1995 and December 2009. Acute mesenteric ischemia (aMI) was present in 10, chronic mesenteric ischemia (cMI) in 14 and visceral artery aneurysm (VAn) in 7 cases. The primary endpoint of this study was vessel patency, secondary endpoints were survival and freedom from reintervention. Results: A total of 46 vessels were revascularized (26 bypass grafts) and additional revascularization procedures (thromboembolectomy, patch plasty, transposition) were performed in 21 cases. In the perioperative period, 6 deaths (5 aMI, 1 cMI) occurred, resulting in a mortality rate of 50 % for aMI and 7 % for cMI. At long-term follow-up (55 months), 22 patients (100 % follow-up) were interviewed and 21 were scheduled for clinical and imaging examinations. Four vessel (3 grafts) occlusions were found in these patients. Conclusion: We were able to show that bypass grafting for a visceral artery pathology, although associated with an increased perioperative mortality, is a successful and durable procedure.

Key words

aorta/aortic - peripheral vascular disease (outside the chest) - atherosclerosis - aneurysm - mesenteric arteries - splanchnic circulation - ischemia - embolism and thrombosis

References

  • 1 Hirsch A T, Haskal Z J, Hertzer N R et al. ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease.  Circulation. 2006;  113 e463-e465
    CrossrefPubMedGoogle Scholar
  • 2 Oderich G S, Malgor R D, Ricotta J J. Open and endovascular revascularization for chronic mesenteric ischemia: tabular review of the literature.  Ann Vasc Surg. 2009;  23 700-712
    CrossrefPubMedGoogle Scholar
  • 3 Kruger A J, Walker P J, Foster W J, Jenkins J S, Boyne N S, Jenkins J. Open surgery for atherosclerotic chronic mesenteric ischemia.  J Vasc Surg. 2007;  46 941-945
    CrossrefPubMedGoogle Scholar
  • 4 Gentile A T, Moneta G L, Taylor Jr L M, Park T C, McConnell D B, Porter J M. Isolated bypass to the superior mesenteric artery for intestinal ischemia.  Arch Surg. 1994;  129 926-931
    PubMedGoogle Scholar
  • 5 Cho J S, Carr J A, Jacobsen G, Shepard A D, Nypaver T J, Reddy D J. Long-term outcome after mesenteric artery reconstruction: a 37-year experience.  J Vasc Surg. 2002;  35 453-460
    CrossrefPubMedGoogle Scholar
  • 6 Thomas J H, Blake K, Pierce G E, Hermreck A S, Seigel E. The clinical course of asymptomatic mesenteric artery stenosis.  J Vasc Surg. 1998;  27 840-844
    CrossrefPubMedGoogle Scholar
  • 7 McMillan W D, McCarthy W J, Bresticker M R et al. Mesenteric artery bypass: objective patency determination.  J Vasc Surg. 1995;  21 729-741
    CrossrefPubMedGoogle Scholar
  • 8 Johnston K W, Lindsay T F, Walker P M, Kalman P G. Mesenteric arterial bypass grafts: early and late results and suggested surgical approach for chronic and acute mesenteric ischemia.  Surgery. 1995;  118 1-7
    CrossrefPubMedGoogle Scholar
  • 9 Kihara T K, Blebea J, Anderson K M, Friedman D, Atnip R G. Risk factors and outcome following revascularization for chronic mesenteric ischemia.  Ann Vasc Surg. 1999;  13 37-44
    CrossrefPubMedGoogle Scholar
  • 10 Jimenez J G, Huber T S, Ozaki C K et al. Durability of antegrade synthetic aortomesenteric bypass for chronic mesenteric ischemia.  J Vasc Surg. 2002;  35 1078-1084
    CrossrefPubMedGoogle Scholar
  • 11 Mateo R B, O'Hara P J, Hertzer N R, Mascha E J, Beven E G, Krajewski L P. Elective surgical treatment of symptomatic chronic mesenteric occlusive disease: early results and late outcomes.  J Vasc Surg. 1999;  29 821-832
    CrossrefPubMedGoogle Scholar
  • 12 Christensen M G, Lorentzen J E, Schroeder T V. Revascularisation of atherosclerotic mesenteric arteries: experience in 90 consecutive patients.  Eur J Vasc Surg. 1994;  8 297-302
    CrossrefPubMedGoogle Scholar
  • 13 Park W M, Cherry K J, Chua H K et al. Current results of open revascularization for chronic mesenteric ischemia: a standard for comparison.  J Vasc Surg. 2002;  35 853-859
    CrossrefPubMedGoogle Scholar
  • 14 Schermerhorn M L, Giles K A, Hamdan A D, Wyers M C, Pomposelli F B. Mesenteric revascularization: management and outcomes in the United States, 1988–2006.  J Vasc Surg. 2009;  50 341-348
    CrossrefPubMedGoogle Scholar
  • 15 Derrow A E, Seeger J M, Dame D A et al. The outcome in the United States after thoracoabdominal aortic aneurysm repair, renal artery bypass and mesenteric revascularization.  J Vasc Surg. 2001;  34 54-61
    CrossrefPubMedGoogle Scholar
  • 16 Indes J E, Giacovelli J K, Muhs B E, Sosa J A, Dardik A. Outcomes of endovascular and open treatment for chronic mesenteric ischemia.  J Endovasc Ther. 2009;  16 624-630
    CrossrefPubMedGoogle Scholar
  • 17 Park W M, Gloviczki P, Cherry K J et al. Contemporary management of acute mesenteric ischemia: Factors associated with survival.  J Vasc Surg. 2002;  35 445-452
    CrossrefPubMedGoogle Scholar
  • 18 Kougias P, Lau D, El Sayed H F, Zhou W, Huynh T T, Lin P H. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia.  J Vasc Surg. 2007;  46 467-474
    CrossrefPubMedGoogle Scholar
  • 19 Modrall J G, Sadjadi J, Joiner D R et al. Comparison of superficial femoral vein and saphenous vein as conduits for mesenteric arterial bypass.  J Vasc Surg. 2003;  37 362-366
    CrossrefPubMedGoogle Scholar
  • 20 Kansal N, LoGerfo F W, Belfield A K et al. A comparison of antegrade and retrograde mesenteric bypass.  Ann Vasc Surg. 2002;  16 591-596
    CrossrefPubMedGoogle Scholar
  • 21 Wolf Y G, Berlatzky Y, Gewertz B L. Sequential configuration for aorto-celiac-mesenteric bypass.  Ann Vasc Surg. 1997;  11 640-642
    CrossrefPubMedGoogle Scholar
  • 22 McAfee M K, Cherry Jr K J, Naessens J M et al. Influence of complete revascularization on chronic mesenteric ischemia.  Am J Surg. 1992;  164 220-224
    CrossrefPubMedGoogle Scholar
  • 23 Foley M I, Moneta G L, Abou-Zamzam A M et al. Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia.  J Vasc Surg. 2000;  32 37-47
    CrossrefPubMedGoogle Scholar
  • 24 Schneider D B, Nelken N A, Messina L M, Ehrenfeld W K. Isolated inferior mesenteric artery revascularization for chronic visceral ischemia.  J Vasc Surg. 1999;  30 51-58
    CrossrefPubMedGoogle Scholar
  • 25 Mikkelsen W P. Intestinal angina – its surgical significance.  Am J Surg. 1957;  94 262-268
    CrossrefPubMedGoogle Scholar
  • 26 Chandra A, Quinones-Baldrich W J. Chronic mesenteric ischemia: how to select patients for invasive treatment.  Semin Vasc Surg. 2010;  23 21-28
    CrossrefPubMedGoogle Scholar
  • 27 Dunbar J D, Molnar W, Beman F F, Marable S A. Compression of the celiac trunk and abdominal angina.  Am J Roentgenol. 1965;  95 731-744
    PubMedGoogle Scholar
  • 28 Reilly L M, Ammar A D, Stoney R J, Ehrenfeld W K. Late results following operative repair for celiac artery compression syndrome.  J Vasc Surg. 1985;  2 79-91
    CrossrefPubMedGoogle Scholar
  • 29 Grotemeyer D, Duran M, Iskandar F, Blondin D, Nguyen K, Sandmann W. Median arcuate ligament syndrome: vascular surgical therapy and follow-up of 18 patients.  Langenbecks Arch Surg. 2009;  394 1085-1092
    CrossrefPubMedGoogle Scholar
  • 30 Brown D J, Schermerhorn M L, Powell R J et al. Mesenteric stenting for chronic mesenteric ischemia.  J Vasc Surg. 2005;  42 268-274
    CrossrefPubMedGoogle Scholar
  • 31 Biebl M, Oldenburg W A, Paz-Fumagalli R, McKinney J M, Hakaim A G. Surgical and interventional visceral revascularization for the treatment of chronic mesenteric ischemia – when to prefer which?.  World J Surg. 2007;  31 562-568
    CrossrefPubMedGoogle Scholar

1 Both authors contributed equally to this work. This work contains parts of the doctoral thesis of B. Ihmels.

PD Dr. Bernhard Dorweiler

Division of Vascular Surgery
Department of Cardiothoracic & Vascular Surgery
University Medical Center

Langenbeckstraße 1

55131 Mainz

Germany

Phone: +49 61 31 17 40 78

Fax: +49 61 31 17 47 68 09

Email: dorweiler@htg.klinik.uni-mainz.de