Open Surgical Treatment for Chronic Mesenteric Ischemia : Revascularization Techniques, Operative and Clinical Outcomes

Abstract

Chronic mesenteric ischemia represents a special challenge in its management. For an optimal revascularization, it requires a great expertise in choosing and carrying out the indicated mesenteric reconstruction. Because of its insidious course, appropriate diagnosis-finding of chronic mesenteric ischemia is not always easy. In its later stages the patients complain of abdominal angina, marked weight loss and ischemic colitis. The clear indication for a vascularsurgical therapy of chronic mesenteric ischemia exists only if there is a stenosis or occlusion of at least 2 of the 3 mesenteric arteries. There are several diagnostic modalities for the diagnosis of mesenteric ischemia such as Duplex-ultrasonography, CTA, MRA and DSA. In principle, there are several reconstruction procedures for the mesenteric vessels. According to the origin of bypass and the direction of arterial flow (compared to the aorta), there are antegrade and retrograde reconstructions. Other surgical techniques such as thrombendarteriectomy and decompression of median arcuate ligament could also be used in some special cases if indicated. The antegrade versus retrograde group offers more primary patency rates perioperatively (90.5 % vs. 70.6 %), this difference was not found at longer follow-up, such as at one year and five years. The benefits of complete revascularization, however, were obtained at the expense of a tendency of more early postoperative complications (83.3 % vs. 55 %). The mortality in the perioperative period was significantly higher in the 2-vessel group (27.8 % vs. 0 %, p=0.017). The vascular surgeon should be prepared to perform various techniques of mesenteric reconstruction (antegrade and retrograde, single or multiple vessels, autologous or alloplastic etc.).