Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia
Open accessAbstract
Objective Complete revascularization is recommended by many authors for treatment of intestinal ischemia. The observation that postprandial intestinal hyperemia is limited to the superior mesenteric artery (SMA) has suggested to us that SMA revascularization alone should be adequate treatment. We preferentially manage intestinal ischemia with a single bypass graft to the SMA and herein update our results using this approach.Methods Patients were identified from a prospectively established vascular surgical registry. Each patient was assessed for acute versus chronic intestinal ischemia, preoperative angiographic findings, operation used, perioperative morbidity and mortality, late symptomatic relief, cause of death, and life table-determined survival and graft patency. Graft patency was determined by follow-up angiography or duplex scanning.Results Fifty bypass grafts to the SMA alone were performed in 49 patients (31 women, 18 men; mean age, 62 years) for treatment of intestinal ischemia. In all patients additional splanchnic arteries were available for bypass grafting. Operative indications were acute symptoms in 21 patients, 14 of whom had bowel infarction; chronic symptoms in 26 patients; and prophylaxis in conjunction with infrarenal aortic surgery in 3 patients. Thirty-two grafts originated from the aorta or an iliac artery, and 18 originated from an aortic graft. There were 40 prosthetic and 10 autogenous conduits. Perioperative mortality was 3% in patients with chronic symptoms and 12% overall. All survivors were symptomatically improved. Mean follow-up was 44 months. Nine-year assisted primary graft patency was 79%, and 5-year patient survival was 61%. Two late deaths occurred in patients with recurrent intestinal ischemia resulting from graft occlusions.Conclusions Bypass grafting to the SMA alone appears to be both an effective and durable procedure for treatment of intestinal ischemia. Our results appear equal to those reported for "complete" revascularization for intestinal ischemia. When the SMA is a suitable recipient vessel, multiple bypass grafts to other splanchnic vessels are unnecessary in the treatment of intestinal ischemia.
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At high-volume centers, CMI surgical revascularization has had operative mortality as high as 12%.
“Results from these relatively high volume centers of excellence have operative mortality up to 12%.1–7”
From Mesenteric revascularization: management and outcomes in the United States, 1988-2006 (2009) · cites this paper as [7]
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Suggested standards for reports dealing with lower extremity ischemia
Rutherford, R. B., Flanigan, D. P., Gupta, S. K., Johnston, K. W., Karmody, A. M., Whittemore, A. D., Baker, J. D., Ernst, C. B., Jamieson, C. W., & Mehta, S. (1986) · Journal of Vascular Surgery · doi:10.1016/0741-5214(86)90326-5 · Cited by 1,079 · see citing works
Acute and Chronic Thrombosis of the Mesenteric Arteries Associated with Malabsorption
Shaw, R. S., & Maynard, E. P. (1958) · New England Journal of Medicine · doi:10.1056/nejm195805012581803 · Cited by 289 · see citing works
Duplex ultrasound measurement of postprandial intestinal blood flow: Effect of meal composition
Moneta, G. L., Taylor, D. C., Helton, W. S., Mulholland, M. W., & Strandness, D. E. (1988) · Gastroenterology · doi:10.1016/0016-5085(88)90364-2 · Cited by 275 · see citing works
Self-citationABDOMINAL PAIN OF VASCULAR ORIGIN
Dunphy, J. E. (1936) · The American Journal of the Medical Sciences · doi:10.1097/00000441-193607000-00014 · Cited by 194 · see citing works
Mateo, R. B., O’Hara, P. J., HERTZER, N. R., Mascha, E. J., Beven, E. G., & Krajewski, L. P. (1999) · Journal of Vascular Surgery · doi:10.1016/s0741-5214(99)70209-0 · Cited by 171 · see citing works
Measurement of mesenteric blood flow by duplex scanning
ger, K. J., Bollinger, A., Valli, C., & Ammann, R. (1986) · Journal of Vascular Surgery · doi:10.1067/mva.1986.avs0030462 · Cited by 166 · see citing works
Mesenteric artery bypass: Objective patency determination
McMillan, W. D., McCarthy, W. J., Bresticker, M. R., Pearce, W. H., Schneider, J. R., Golan, J. F., & Yao, J. S. T. (1995) · Journal of Vascular Surgery · doi:10.1016/s0741-5214(05)80004-7 · Cited by 162 · see citing works
WAYNEJOHNSTON, K., LINDSAY, T., WALKER, P., & KALMAN, P. (1995) · Surgery · doi:10.1016/s0039-6060(05)80002-9 · Cited by 159 · see citing works
Surgical management of chronic intestinal ischemia: a reappraisal.
Hollier, L. H., Bernatz, P. E., Pairolero, P. C., Payne, W. S., & Osmundson, P. J. (1981) · PubMed · Cited by 155 · see citing works
Mikkelsen, W. P. (1957) · The American Journal of Surgery · doi:10.1016/0002-9610(57)90654-2 · Cited by 151 · see citing works
Influence of complete revascularization on chronic mesenteric ischemia
McAfee, M. K., Cherry, K. J., Naessens, J. M., Pairolero, P. C., Hallett, J. W., Gloviczki, P., & Bower, T. C. (1992) · The American Journal of Surgery · doi:10.1016/s0002-9610(05)81074-8 · Cited by 135 · see citing works
Durability of endarterectomy and antegrade grafts in the treatment of chronic visceral ischemia
Rapp, J. H., Reilly, L. M., Qvarfordt, P. G., Goldstone, J., Ehrenfeld, W. K., & Stoney, R. J. (1986) · Journal of Vascular Surgery · doi:10.1016/0741-5214(86)90045-5 · Cited by 130 · see citing works
Surgical treatment of chronic mesenteric arterial insufficiency
Rheudasil, J. M., Stewart, M. T., Schellack, J. V., Smith, R. B., Salam, A. A., & Perdue, G. D. (1988) · Journal of Vascular Surgery · doi:10.1016/0741-5214(88)90117-6 · Cited by 122 · see citing works
Current Results of Surgical Therapy for Chronic Mesenteric Ischemia
Moawad, J. A. (1997) · Archives of Surgery · doi:10.1001/archsurg.1997.01430300055012 · Cited by 122 · see citing works
CUNNINGHAM, C. G., REILLY, L. M., RAPP, J. H., SCHNEIDER, P. A., & STONEY, R. J. (1991) · Annals of Surgery · doi:10.1097/00000658-199109000-00010 · Cited by 112 · see citing works
Does ‘intestinal angina’ exist? A critical study of obstructed visceral arteries
Croft, R. J., Menon, G., & Marston, A. (1981) · British journal of surgery · doi:10.1002/bjs.1800680509 · Cited by 95 · see citing works
Use of hemodynamic parameters in the diagnosis of mesenteric insufficiency
Nicholls, S. C., Kohler, T. R., Martin, R. L., & Strandness, D. E. (1986) · Journal of Vascular Surgery · doi:10.1016/0741-5214(86)90117-5 · Cited by 92 · see citing works
Isolated Bypass to the Superior Mesenteric Artery for Intestinal Ischemia
Gentile, A. T. (1994) · Archives of Surgery · doi:10.1001/archsurg.1994.01420330040009 · Cited by 89 · see citing works
Treatment of chronic visceral ischemia
Baur, G. M., Millay, D. J., Taylor, L. M., & Porter, J. M. (1984) · The American Journal of Surgery · doi:10.1016/0002-9610(84)90301-5 · Cited by 81 · see citing works
Self-citationChronic intestinal ischemia: Diagnosis and therapy
Stanton, P. E., Hollier, P. A., Seidel, T. W., Rosenthal, D., Clark, M., & Lamis, P. A. (1986) · Journal of Vascular Surgery · doi:10.1016/0741-5214(86)90226-0 · Cited by 74 · see citing works
Long-term results of the surgical management of symptomatic chronic intestinal ischemia.
Calderón, M. R. S., Reul, G. J., Gregorič, I. D., Jacobs, M. J. H. M., Duncan, J. M., Ott, D. A., Livesay, J. J., & Cooley, D. A. (1992) · PubMed · Cited by 72 · see citing works
Kiény, R., Batellier, J., & Kretz, J. (1990) · Annals of Vascular Surgery · doi:10.1007/bf02001365 · Cited by 68 · see citing works
Risk Factors and Outcomes following Revascularization for Chronic Mesenteric Ischemia
Kihara, T. K., Blebea, J., Anderson, K. M., Friedman, D., & Atnip, R. G. (1999) · Annals of Vascular Surgery · doi:10.1007/s100169900218 · Cited by 68 · see citing works
Cormier, J. M., Fichelle, J. M., Vennin, J., Laurian, C., & Gigou, F. (1991) · Annals of Vascular Surgery · doi:10.1007/bf02015274 · Cited by 68 · see citing works
Wylie, E. J., Stoney, R. J., & Ehrenfeld, W. K. (1980) · Comprehensive manuals of surgical specialties · doi:10.1007/978-1-4612-6021-9 · Cited by 35 · see citing works
Intestinal gangrene as the result of mesenteric arterial steal
Connolly, J. E., & Stemmer, E. A. (1973) · The American Journal of Surgery · doi:10.1016/s0002-9610(73)80153-9 · Cited by 31 · see citing works
Conn, J. (1981) · JAMA · doi:10.1001/jama.1981.03310310064035 · Cited by 7 · see citing works
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Self-citationSystematic review of survival after acute mesenteric ischaemia according to disease aetiology
Schoots, I. G., Koffeman, G. I., Legemate, D. A., Levi, M., & van Gulik, T. M. (2004) · Journal of British Surgery · doi:10.1002/bjs.4459 · Cited by 502 · see citing works
Contemporary management of acute mesenteric ischemia: Factors associated with survival
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Mesenteric revascularization: management and outcomes in the United States, 1988-2006
Schermerhorn, M. L., Giles, K. A., Hamdan, A. D., Wyers, M. C., & Pomposelli, F. B. (2009) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2009.03.004 · Cited by 311 · see citing works
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Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review
Kassahun, W. T., Schulz, T., Richter, O., & Hauss, J. (2008) · Langenbeck's Archives of Surgery · doi:10.1007/s00423-007-0263-5 · Cited by 262 · see citing works
Atkins, M. D., Kwolek, C. J., LaMuraglia, G. M., Brewster, D. C., Chung, T. K., & Cambria, R. P. (2007) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2007.01.067 · Cited by 217 · see citing works
Current results of open revascularization for chronic mesenteric ischemia: a standard for comparison
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Open versus endovascular revascularization for chronic mesenteric ischemia: Risk-stratified outcomes
Oderich, G. S., Bower, T. C., Sullivan, T. M., Bjarnason, H., Cha, S., & Gloviczki, P. (2009) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2009.02.006 · Cited by 186 · see citing works
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Acute occlusive mesenteric ischemia: surgical management and outcomes
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Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery
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Long-term outcome after mesenteric artery reconstruction: a 37-year experience
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Intermediate-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia
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Kougias, P., El Sayed, H. F., Zhou, W., & Lin, P. H. (2007) · Journal of Endovascular Therapy · doi:10.1583/07-2102.1 · Cited by 71 · see citing works
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- Authors
- Foley, M. I., Moneta, G. L., Abou-Zamzam, A. M., Edwards, J. M., Taylor, L. M., Yeager, R. A., & Porter, J. M.
- Affiliations
- Oregon Health & Science University (US)
- ORCID
- Edwards, James M.
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2000-07
- Volume
- 32
- Issue
- 1
- Pages
- 37-47
- ISSN
- 0741-5214 (ISSN-L)
- OpenAlex
- W1973225862
- Cited by
- 181
- References
- 27
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 5 · 2020: 6 · 2019: 5 · 2018: 8 · 2017: 8 · 2016: 7 · 2015: 5 · 2014: 9 · 2013: 5 · 2012: 10
- FWCI
- 7.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Surgery › Infectious Aortic and Vascular Conditions
- Keywords
- superior mesenteric artery, intestinal ischemia, graft patency, patient survival, bowel infarction, perioperative mortality
- MeSH terms
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Arteries, Chronic Disease, Female, Humans, Intestines, Ischemia, Male, Middle Aged, Vascular Surgical Procedures, Mesenteric Artery, Superior, Blood Vessel Prosthesis Implantation
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