Is the thoracic aorta a safe site for the proximal anastomosis for bypassing the mesenteric arteries in patients with chronic mesenteric ischaemia?

Abstract

A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether the thoracic aorta is a safe site for the proximal anastomosis when bypassing the mesenteric arteries in patients with chronic mesenteric ischaemia. Five articles reported the use of the thoracic aorta as the site of proximal anastomosis in 35 patients with chronic mesenteric ischaemia. All of these studies were retrospective case reports or case series. The ascending aorta was the site for the proximal anastomosis in 7 patients with the descending thoracic aorta being used in the other 28 patients. The ascending aorta was used when there was disease of the descending thoracic aorta. Out of the 35 patients there was only 1 perioperative death (3%). Rates of graft patency and freedom from recurrent symptoms were excellent. The published literature supports the use of the thoracic aorta as an option for the site of the proximal anastomosis when bypass from elsewhere is not possible.

Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery

“…The potential options in this setting included replacing the involved aortoiliac segment or simply choosing another inflow site. A variety of alternative inflow sources have been describe, including the ascending aorta, 145 the descending aorta, 145 and the axillary artery, 146 although the published experience is small.…”

Chronische mesenteriale Ischämie

“…Mögliche andere Spendergefäße sind die supratrunkale Aorta (in der Regel weniger arteriosklerotische Veränderungen) oder die infrarenale Aorta. Andere aber sehr selten genutzte Anschlussmöglichkeiten stellen die Aorta ascendens oder die A. axillaris dar [2,33].…”