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Chronic mesenteric ischemia is a life-threatening clinical problem resulting in death from inanition and/or bowel infarction, if left untreated, albeit low disease prevalence. Typical presentation is postprandial abdominal pain, severe weight loss, and altered bowel habit. Surgical revascularization of the superior mesenteric artery provides effective long-term treatment for chronic intestinal ischemia. Eleven patients underwent superior mesenteric artery revascularization, nine of them with open retrograde superior mesenteric artery bypass and two with angioplasty and stenting. All patients except one made a satisfactory recovery in this cohort. Major complication included one graft thrombosis leading to bowel ischemia and death. The rest all recovered weight in 3-6 months with a follow up period of 6 to 28 months. Two patients had recurrence of symptoms due to failing bypass requiring stenting for assisted primary patency. Superior mesenteric artery revascularization can be performed with minimal morbidity and mortality, providing excellent symptom relief and quality of life.

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A 41-year-old physical trainer was detected to have type III aortic dissection while being evaluated for left-side chest pain and hypertension of 5 months' duration. On medications (atenelol 50 mg once daily and hydrochlorothiazide 25 mg twice daily), hypertension was controlled to 160/80 mm Hg with lower limb blood pressure of 110 mm Hg. Computed tomography angiogram revealed classic postsubclavian coarctation of aorta, double-barreled aorta in the postcoarct segment, and an intimal flap involving thoracic and abdominal aorta up to the origin of the superior mesenteric artery (A/Cover). He underwent repair of the twin lesions (B) of the thoracic aorta using a 24-mm coated polyester vascular graft (Albograft; Edwards Life Sciences SA, Nyon, Switzerland) under cardiopulmonary bypass (CPB) and total circulatory arrest. CPB was achieved using bifurcated arterial return to the right axillary and left femoral arteries, and venous return was achieved through the right femoral vein and the main pulmonary artery. Total circulatory arrest time was 30 minutes. Postoperative recovery was uneventful, and he left the hospital on the 10th postoperative day fully recovered except for left recurrent laryngeal nerve paresis. His blood pressure was easily controlled with atenelol 25 mg once daily. On discharge, his ankle-brachial index was 0.85 bilateral. Follow-up computed tomography angiogram confirmed intact repair and patent graft (C), and at 6-month follow-up, he is fully active and back to profession. The combination of significant coarctation of the aorta and a type B equivalent dissection is an extremely rare event. 1 It requires resection of the segment of aorta involved along with the coarctation segment and aortic continuity re-established with an interposed tubular polyester graft under aid of CPB. The procedure could be hazardous, particularly with regard to hemostatic control of the large intercostal arteries feeding into the aneurysm and injury to the pulmonary artery, the phrenic, and the recurrent laryngeal nerve. Postrepair paraplegia is a greater than usual hazard because of the need to sacrifice intercostal arteries. 2 Circulatory arrest allows for the accurate repair of this difficult pathologic process and avoids the risk of clamprelated injuries. 3 Endovascular repair in this setting of complex thoracic aortic pathology in this 40-year-old patient is limited or nonavailable, hence open surgery is life saving, durable, and is currently an exclusive therapeutic strategy.