Revascularization for Chronic Mesenteric Ischemia: 55 Years of Progress

Valeriy S. Arakelyan, Roman G. Bukatsello, Inna V. Chshieva

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.26 08:30, Exhibition area, 1st Floor. Zone – B

Abstract

Objective:

Occlusive disease of the mesenteric circulation is a major surgical challenge.  Evolution in the operative approach and progress in the intraoperative management prompted a review of our cumulative experience in the management of chronic visceral ischemia.

Methods:

The records of all patients (n=369) who underwent visceral revascularization during the past five decades (from 1962 to 2017) were identified.

Open mesenteric revascularization (OR) with bypass (in 4 patients), graft replacement (in 26 patients) or endarterectomy (in 115 patients) were completed. Mesenteric stenting (in 30 patients) was used in the elderly or/end higher-risk patient.

Congenital or acquired mid-aortic syndrome was the was the cause of chronic mesenteric ischemia (CMI) in 16 patients (0,43%). Open surgical reconstruction (in 10 patients) and aortic graft replacement (in 7 patients) were carried out.

69 patients with CMI had Takayasu’s arteritis. Mainly OR methods were used.

Median arcuate ligament syndrome (MALS) - in 109 patients (29,5%). Surgery was the main method of treatment.

Results:

30 day mortality was higher for high-risk patients in the reconstruction group of 5.4%, in the decompression and endovascular group there was no in hospital mortality. Major complications were found in 13.9%, 11.8 and 6.7% of cases in the reconstructive, decompression and endovascular groups, respectively.  In the long-term period follow up (n = 122), the rate of restenosis was highest in the endovascular group - 23.3%. By the 3rd year follow-up, the primary patency for open and endovascular operations was 96.3 and 81.3%, respectively. 

Conclusion:

Complete surgical revascularization remains the treatment of choice for patients with nonatherosclerotic cause of CMI. Endovascular repair should be used as first approach in patients who have suitable lesions, independent of their surgical risk.