Open surgery for atherosclerotic chronic mesenteric ischemia

Abstract

Open surgical mesenteric revascularization by bypass grafting for atherosclerotic-induced chronic mesenteric ischemia can be performed with low mortality and morbidity and provides excellent long-term primary patency rates and symptom-free outcomes. Pending more data on the acute and long-term results of endovascular techniques, open mesenteric revascularization remains the gold standard for most patients with chronic mesenteric ischemia.

Outcomes after endarterectomy for chronic mesenteric ischemia

“…2 Vague symptoms can delay diagnosis, although postprandial pain and weight loss are common and may be present in up to 90% of patients. 3 Undiagnosed CMI results in severe nutritional depletion, and may progress to acute mesenteric ischemia and intestinal infarction. Emergency operation for acute mesenteric ischemia is associated with a mortality of up to 60%.…”

“…Open surgical revascularization is still considered the standard of care, but may be associated with significant morbidity and mortality. [1][2][3][4][5][6][7][8][9][10][11][12] Percutaneous approaches have been suggested to play an increased role in the treatment of CMI because of high initial technical success and low morbidity [13][14][15][16] ; however, they have been associated with poor long-term patency and a high rate of recurrent symptoms requiring reintervention.…”

Endovascular versus open revascularization for chronic mesenteric ischemia: a comparative study

“…PTA of SMA occlusion has been reported to be more challenging with lower patency [11]. In these cases, we suggest that OR should be considered despite high operative risk [18].…”

Akute intestinale Ischämie

“…Bildgebende Verfahren sind zur Indikationsstellung wenig hilfreich, so dass die Indikation anhand des intraoperativen Erstbefundes und des klinischen Verlaufes zu stellen ist. Dies gilt insbesondere dann, wenn keine Kreislaufstabilisierung eintritt, das Serumlaktat nicht abfällt oder ein vaskulärer Rezidivverschluss nachgewiesen wurde [7,8]. Neben der anhaltenden oder neu auftretenden intestinalen Ischämie kön-nen weitere Komplikationen auftreten, die ihrerseits zu therapieren sind (.…”