Purpose: Mesenteric revascularization for chronic mesenteric ischemia (CMI)
traditionally involves antegrade or retrograde bypass graft originating fr
om the supraceliac or infrarenal aorta. The distal thoracic aorta (DTA) may
provide a better inflow source than the abdominal aorta. The purpose of th
is study was to evaluate the results with the DTA used as inflow for the su
rgical treatment of CMI.
Methods: All patients undergoing mesenteric revascularization for CMI with
grafts originating from the DTA were identified from 1990 to 1999. A ninth
interspace thoracoretroperitoneal incision was used for exposure, and dista
l aortic flow was maintained by use of a partial occlusion clamp.
Results: Eighteen consecutive patients with CMI underwent mesenteric bypass
grafting with the DTA used as inflow. All patients were admitted with chro
nic abdominal pain or weight loss, with two (12%) requiring urgent revascul
arization because of acute exacerbation of chronic symptoms. Fourteen (78%)
patients had both celiac and superior mesenteric artery bypass grafts plat
ed, and three (17%) patients had superior mesenteric artery grafts alone. T
here was one (6%) perioperative death and three (17%) major complications.
There was no kidney failure, mesenteric infarction, or spinal cord ischemia
. The life-table survival rate was 89%, 89%, and 76% at 1, 3, and 5 years,
respectively. All 18 patients remained symptom free and required no additio
nal procedures to assist patency. There was no evidence of graft stenosis o
r occlusion (100% patency) for those grafts evaluated objectively during th
e mean follow-up of 34.8 months (range, 1-97 months).
Conclusions: Antegrade mesenteric revascularization with the DTA used as in
flow is associated with low morbidity and mortality rates. Furthermore, it
provides excellent midterm patency and survival results and should be consi
dered as a primary approach for reconstruction of patients with CMI.