ISOLATED BYPASS TO THE SUPERIOR MESENTERIC-ARTERY FOR INTESTINAL ISCHEMIA

Objective: A number of reports indicate revascularization for intestin al ischemia should include the superior mesenteric artery (SMA) and th e celiac artery. However, no controlled or randomized studies have pro ven this approach superior to SMA bypass alone. We report our results using bypass to only the SMA for intestinal ischemia. Design: Retrospe ctive review with mean follow-up of 40 months (range, 2 to 110 months) . Setting: University medical center and Veterans Affairs hospital. Pa tients/Methods: The records of patients who underwent intestinal revas cularization of the SMA alone from 1982 through 1993 were reviewed. Pa tients were assessed for indication for operation, operative technique , perioperative mortality, and long-term outcome. The SMA grafts were examined for patency within the last 6 months using duplex scanning or arteriography. Patient survival and graft patency rates were calculat ed using life-table methods. Results: Twenty-nine bypasses to only the SMA were performed in 26 patients (16 female and 10 male; mean age, 5 9 years; age range, 13 to 81 years). Indication for operation was symp tomatic chronic mesenteric ischemia in 23 cases and acute intestinal i schemia in five cases. One bypass was performed for asymptomatic SMA o cclusion. There were three perioperative deaths (10% mortality rate), all in patients with acute intestinal ischemia and previous mesenteric arterial surgery. Life-table 4-year primary graft patency and patient survival rates were 89% and 82%, respectively. Symptomatic improvemen t was maintained in all patients available for follow-up. Conclusion: Revascularization of only the SMA for intestinal ischemia provides exc ellent graft patency with acceptable perioperative mortality and long- term patient survival. The SMA bypass alone for intestinal ischemia ap pears as successful as bypasses to multiple visceral vessels.