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Cited by 145Abdominal vascular conditions and treatmentsPeripheral Artery Disease ManagementAortic Thrombus and Embolism

Long-term outcome after mesenteric artery reconstruction: a 37-year experience

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Cho, Jae-Sung, Carr, John A., Jacobsen, Gordon, Shepard, Alexander D., Nypaver, Timothy J., Reddy, Daniel J.·2002·Journal of Vascular Surgery
DOI 10.1067/mva.2002.118593
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Abstract

Purpose The purpose of this study was the definition of the late results and determining factors after mesenteric artery reconstruction (MAR) for atherosclerotic mesenteric ischemia.Methods A retrospective review identified 48 consecutive patients (66 arteries) who underwent MAR for acute mesenteric ischemia (AMI) of nonembolic origin (n = 23; 12 with and 11 without prior symptoms) and chronic mesenteric ischemia (CMI; n = 25) from 1963 to 2000 in a tertiary care referral center. The 29 women (60%) and the 19 men (40%) had a mean age of 64 years (range, 40 to 87 years). The operative procedures consisted of bypass grafting in 36 arteries (AMI, 12; CMI, 24), local endarterectomy (LEA) in 16 arteries (AMI, 9; CMI 7), and transaortic endarterectomy (TAE) in 14 arteries (AMI, 4; CMI, 10). The follow-up of the 34 survivors was complete in all but four patients and averaged 5.3 years (range, 30 days to 36 years). Radiographic documentation of vessel/graft patency was obtained in 33 of 34 survivors.Results Single-vessel revascularization was performed more frequently in the AMI group than in the CMI group (91% versus 48%; P =.001). The perioperative (<30 days) mortality rate in the AMI group was 52% (12 of 23 cases) as compared with 0 of 25 cases in the CMI group (P <.001). Bowel infarction was the cause of nine deaths. Major complications occurred in 60% of the cases. Fifteen late graft failures occurred, for a cumulative patency rate of 57% at 5 years and 46% at 10 years. TAE was associated with improved patency rates as compared with LEA (TAE versus LEA; P =.002). Symptomatic recurrences developed in eight patients, all involving superior mesenteric artery thrombosis (P <.001). The freedom-from-recurrence rates in the survivors were 79% at 5 years and 59% at 10 years. The late survival rates were 54% and 20% at 5 and 10 years, respectively. With the exclusion of perioperative deaths, the probability of long-term survival was 77% at 5 years and 29% at 10 years and did not differ between AMI and CMI.Conclusion Although MAR for CMI carries a low mortality rate, AMI remains a lethal and frequently unheralded problem. Long-term patency and symptom-free survival can be expected after successful MAR for AMI and is comparable with those rates achieved after MAR for CMI. The patency of the SMA is important in the prevention of symptomatic recurrences. Elective MAR is indicated in patients with CMI and warrants long-term surveillance.

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Authors
Cho, J.-S., Carr, J. A., Jacobsen, G., Shepard, A. D., Nypaver, T. J., & Reddy, D. J.
Affiliations
Henry Ford Health (US)
ORCID
Venue
Journal of Vascular Surgery
Publisher
Elsevier BV
Published
2002-03
Volume
35
Issue
3
Pages
453-460
ISSN
0741-5214 (ISSN-L)
DOI
10.1067/mva.2002.118593
OpenAlex
W2098339696
Cited by
145
References
32
Citations by year
2026: 1 · 2025: 2 · 2024: 4 · 2023: 1 · 2021: 5 · 2020: 5 · 2019: 3 · 2018: 5 · 2017: 3 · 2016: 8 · 2015: 6 · 2014: 6 · 2013: 10 · 2012: 5
FWCI
4.45
Type
journal article
Language
en
Open access
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 › Pulmonary and Respiratory Medicine › Aortic Thrombus and Embolism
Keywords
acute mesenteric ischemia, chronic mesenteric ischemia, graft patency, bypass grafting, superior mesenteric artery thrombosis, long-term outcomes, perioperative mortality, postoperative complications, recurrence, bowel infarction
MeSH terms
Acute Disease, Adult, Aged, Aged, 80 and over, Arterial Occlusive Diseases, Chronic Disease, Female, Follow-Up Studies, Humans, Ischemia, Male, Mesenteric Arteries, Michigan, Middle Aged, Postoperative Complications, Radiography, Recurrence, Risk Factors, Time, Time Factors, Vascular Patency, Vascular Surgical Procedures, Survival Analysis, Treatment Outcome

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