MESENTERIC-ARTERY BYPASS - OBJECTIVE PATENCY DETERMINATION

Purpose: Many authors have reported extended relief of intestinal isch emia by use of a variety of reconstructive techniques, but ah have rel ied on symptomatic follow-up. None have objectively measured patency r ates. The purpose of this study was to determine the primary patency r ates of bypass grafts placed for acute and chronic splanchnic atherosc lerotic occlusive disease with use of objective follow-up with mesente ric duplex ultrasound scanning or arteriography.; Methods: Twenty-five consecutive patients (mean age 61, female/male ratio of 2.7:1) who un derwent placement of 38 splanchnic bypass grafts (29 saphenous vein gr afts, 9 polytetrafluoroethylene) (22 retrograde, 16 antegrade) for isc hemic symptoms (9 acute ischemia: 16 chronic ischemia) between 1984 an d 1994 were monitored with either duplex scanning (30 grafts) or arter iography. Life-table and log rank analysis were used to determine and compare graft patency. Results: Three patients (12%, 2 acute ischemia and 1 chronic ischemia) died after operation. Six patients (30%) had s ignificant morbidity (4 acute ischemia and 2 chronic ischemia). During follow-up from 1 to 136 months (mean 35 months), no patient died of b owel infarction or required revision for recurrent symptoms. Objective testing revealed three graft occlusions. Symptomatic follow-up had a sensitivity of only 33% for graft occlusion when compared with objecti ve measurement. The life-table primary patency rate was 89% at 72 mont hs. Life-table survival for the same patients was 75% at 36 months. Pa tency rates for antegrade (93% at 36 months) versus retrograde (95% at 36 months) bypass and saphenous vein grafts (95% at 36 months) versus polytetrafluoroethylene (89% at 36 months) were not significantly dif ferent (p = 0.47 and 0.43, respectively). Late patency rates of grafts placed for acute ischemia (92% at 36 months) versus chronic ischemia (89% at 36 months) were not significantly different (p = 0.77). Conclu sion: Splanchnic bypass for mesenteric ischemia, with a primary patenc y rate of 89% at 72 months, is an extremely durable form of revascular ization. Long-term patency of grafts placed for acute ischemia does no t differ significantly from that of bypasses for chronic occlusion. Du plex scanning allows standardized objective periodic follow-up of spla nchnic reconstruction. Objective assessment is critical to accurately measure visceral revascularization patency rates.