Elective surgical treatment of symptomatic chronic mesenteric occlusive disease: Early results and late outcomes

Purpose: The purpose of this study was to determine the safety and efficacy of the elective surgical treatment of symptomatic chronic mesenteric occlu sive disease (SCMOD) and to identify the factors that influence the results of this procedure. Methods: From 1977 to 1997, 85 patients (mean age, 62 years) underwent elec tive surgical treatment of SCMOD. The presenting symptoms were abdominal pa in in 78 patients (92%) and weight loss in 74 patients (87%). The surgical procedures included retrograde bypass grafting in 34 patients (40%), antegr ade bypass grafting in 24 patients (28%), transaortic endarterectomy in 19 patients (22%), local arterial endarterectomy with patch angioplasty in six patients (7%), thrombectomy alone in one patient (1%), and superior mesent eric artery reimplantation in one patient (1%). Thirty-five patients (41%) underwent concomitant aortic replacement. All the involved mesenteric vesse ls were revascularized in 21 patients (25%), whereas revascularization was incomplete for the remaining 64 patients (75%). Late information was availa ble for all 85 patients at a mean interval of 4.8 years. Results: There were seven early (<35 days) postoperative deaths (8%). The c umulative 5-year survival rate was 64% (95% confidence interval [CI], 53% t o 75%), and the a-year symptom-free survival rate was 81% (95% CI, 72% to 9 0%). Serious complications occurred in 28 patients (33%). The results of un ivariate analysis identified advancing age at operation (P < .001), cardiac disease (P = .03), hypertension (P = .03), and additional occlusive diseas e (P = .05) as variables associated with mortality. Concomitant aortic repl acement (P = .037), renal disease (P = .011), advancing age (P = .035), and complete revascularization (P = .032) were associated with postoperative m orbidity including mortality. Late recurrent mesenteric occlusive disease w as seen in 21 patients (16 symptomatic and five asymptomatic). Nine patient s (43%) died, and 8 patients (38%) required subsequent surgical or endovasc ular procedures to treat their recurrent lesions. The 3-year survival rate from recurrent mesenteric occlusive disease was 76% (95% CI, 66% to 86%). Conclusion: We conclude that the elective surgical treatment of SCMOD may b e performed with reasonable early and late mortality rates and that most of the patients remain free from recurrent symptoms of mesenteric ischemia. A dvancing age, cardiac disease, hypertension, and additional occlusive disea se significantly influenced the overall mortality rates, and concomitant ao rtic replacement, renal disease, and complete revascularization were signif icantly associated with postoperative morbidity rates. Surveillance and app ropriate correction of recurrent disease appear to be necessary for optimal long-term results.