Isolated inferior mesenteric artery revascularization for chronic visceralischemia

Purpose: Complete visceral artery revascularization is recommended for the treatment of chronic visceral ischemia. However, in rare cases, it may not be possible to revascularize either the celiac or superior mesenteric (SMA) arteries. We have managed a series of patients with isolated revasculariza tion of the inferior mesenteric artery (IMA) and now report our experience gained over a period of three decades. Methods: Records were reviewed from 11 patients with chronic visceral ische mia who underwent isolated IMA revascularization (n = 8) or who, because of failure of concomitant celiac or SMA repairs, were functionally left with an isolated IMA revascularization (n = 3). All the patients had symptomatic chronic visceral ischemia documented with arteriography. Five patients had recurrent visceral ischemia after failed visceral revascularization, and t wo patients had undergone resection of ischemic bowel. The celiac or the SM A was unsuitable for revascularization in five cases, and extensive adhesio ns precluded safe exposure of the celiac or the SMA in five cases. IMA reva scularization techniques included: bypass grafting (n = 4), transaortic end arterectomy (n = 4), reimplantation (n = 2), and patch angioplasty (n = 1). Results: There was one perioperative death, and the remaining 10 patients h ad cured or improved conditions at discharge. One IMA repair thrombosed acu tely but was successfully revascularized at reoperation. The median follow- up period was 6 years (range, 1 month to 13 years). Two patients had recurr ent symptoms develop despite patent IMA repairs and required subsequent vis ceral revascularization; interruption of collateral circulation by prior bo wel resection may have contributed to recurrence in both patients. Objectiv e follow-up examination with arteriography or duplex scanning was available for eight patients at least 1 year after IMA revascularization, and all un derwent patent IMA repairs. There were no late deaths as a result of bowel infarction. Conclusion: Isolated IMA revascularization may be useful when revasculariza tion of other major visceral arteries cannot be performed and a well-develo ped, intact IMA collateral circulation is present. In this select subset of patients with chronic visceral ischemia, isolated IMA revascularization ca n achieve relief of symptoms and may be a lifesaving procedure.