The Surgical Treatment of Chronic Intestinal Ischemia: Results of a recent series

Abstract

Due to the rarity of the condition, large and prospective series defining the optimal method of digestive arteries revascularization, for the treatment of chronic intestinal ischemia, are lacking. The aim of this consecutive sample clinical study was to test the hypothesis that flexible application of different revascularization methods, according to individual cases, will yield the best results in the management of chronic intestinal ischemia. Eleven patients, of a mean age of 56 years, underwent revascularization of 11 digestive arteries for symptomatic chronic mesenteric occlusive disease. Eleven superior mesenteric arteries and one celiac axis were revascularized. The revascularization techniques included retrograde bypass grafting in 7 cases, antegrade bypass grafting in 2, percutaneous arterial angioplasty in 1, and arterial reimplantation in one case. The donor axis for either reimplantation or bypass grafting was the infrarenal aorta in 4 cases, an infrarenal Dacron graft in 4, and the celiac aorta in one case. Grafting materials included 5 polytetrafluoroethylene (PTFE) and 3 Dacron grafts. Concomitant procedures included 3 aorto-ilio-femoral grafts and one renal artery revascularization. Mean follow-up duration was 31 months. There was no operative mortality. Cumulative survival rate was 88.9% at 36 months (SE 12.1%). Primary patency rate was 90% at 36 months (SE 11.6%). The symptom free rate was 90% at 36 months (SE 11.6%). Direct reimplantation, antegrade and retrograde bypass grafting, all allow good mid-term results: the choice of the optimal method depends on the anatomic and general patient's status. Associated infrarenal and renal arterial lesions can be safely treated in the same time of digestive revascularization. Angioplasty alone yields poor results and should be limited to patients at poor risk for surgery.

Fondaparinux for intra and perioperative anticoagulation in patients with heparin-induced thrombocytopenia candidates for peripheral vascular surgery: Report of 4 cases

“…Beside the limitations of any small patients’ cohort, this study has the disadvantage of dealing with axillo-femoral and femoro-popliteal bypasses or splenic artery aneurysm resection, thus not testing fondaparinux in the setting of aortic surgery, which is expected to be associated with a higher bleeding risk than the former operations. Although aortic and digestive arteries surgery under dual antiplatelet treatment has been reported [20] , [21] , large experience with the combination of dual antiplatelet treatment and fondaparinux in this setting is lacking. Apart such limitations, the results of this study support the off-label use of fondaparinux for peripheral vascular surgery in patients with HIT.…”

Chronic Mesenteric Ischemia: Differential Vascularsurgical Therapy and Its Outcome in a Single-Center Observational Study

“…Postoperative outcome of the current study and of previous reports at the follow-up period[23,38,40,41,[43][44][45][46] …”

Reconstruction of superior mesenteric artery by prostheses placement in a case of chronic mesenteric ischemia: A case report and literature review

“…At present, the main options of treatment are represented by endovascular and open approach. While endovascular surgery is usually less invasive than open surgery, being the initial option of choice in a significant number of cases, its results might be less durable and open approach might be needed if Reconstruction of superior mesenteric artery by prostheses placement in a case of chronic mesenteric ischemia: A case report and literature review symptoms reappear (8)(9)(10). The present study report a case of a 47-year-old man in whom re-appearance of symptoms after endovascular treatment imposed performing an open approach.…”