Single celiac-superior mesenteric artery bypass: An alternative in mesenteric ischemia

Operative reconstruction of the visceral vessels continues to have a high m ortality rate. In this report, the authors describe a series of patients in whom a unique method of visceral reconstruction was employed. The single c eliac-superior mesenteric artery (SMA) bypass, originating from and patchin g the celiac origin, and coursing to the SMA, is an effective way to revasc ularize both of these vessels. Fourteen mesenteric reconstructions performe d in 12 patients (eight men and four women, mean age: 66 years) between 198 9 and 1996 were reviewed. Eight patients had chronic intestinal ischemia (p ostprandial pain, mean weight loss 44 lb) for a mean duration of 11 months, and four patients had acute intestinal ischemia with peritonitis. Reconstr uctive procedures included seven single celiac-SMA bypasses; four bypasses from the aorta to the SMA, celiac artery, or both; one iliosuperior mesente ric bypass; and two visceral patch angioplasties. All single celiac-SMA byp asses remained patent; however, two of four antegrade aortomesenteric recon structions failed within 24 hours. Operative time was shorter for single ce liac-SMA bypasses than for other reconstructions (168 vs 231 min). Mortalit y rate was 25% (two of eight) in the patients with chronic ischemia, and 10 0% in those with acute ischemia. Long-term follow-up (15.5 months) in the s ix survivors operated on for chronic ischemia demonstrated resolution of sy mptoms in all. The single celiac-SMA bypass is an effective and expeditious method of visceral revascularization, with a short, straight graft. This t echnique requires two anastomoses instead of three, minimizes intraoperativ e intestinal ischemia, and is easily performed with prosthetic or autologou s material.