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Cited by 112Abdominal vascular conditions and treatmentsPeripheral Artery Disease ManagementAortic Thrombus and Embolism

Chronic visceral ischemia

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CUNNINGHAM, CHRISTOPHER G., REILLY, LINDA M., RAPP, JOSEPH H., SCHNEIDER, PETER A., STONEY, RONALD J.·1991·Annals of Surgery
DOI 10.1097/00000658-199109000-00010PMC PMC1358647
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Abstract

Symptomatic visceral atherosclerosis is a major surgical challenge because of its life-threatening course and the complexity of its definitive operative treatment. Evolution in the operative approach to the visceral aorta and progress in the intraoperative management of patients undergoing complex vascular reconstructions prompted a review of the authors' cumulative experience in the surgical management of chronic visceral ischemia. Among all patients undergoing visceral revascularization at the University of California, San Francisco during the past three decades, 74 patients were identified whose primary reconstruction used transaortic endarterectomy (TA TEA) (n = 48) or antegrade bypass (AB) (n = 26), the authors' preferred revascularization techniques. The two treatment groups were comparable in gender distribution, age, presenting symptoms, and physical findings, although the amount of preoperative weight loss was greater in the AB group (35.8 +/- 19.5 versus 22.4 +/- 12.0, p = 0.003). The groups were also comparable in the prevalence of atherosclerosis risk factors, symptomatic vascular disease at other sites, and previous vascular operations. However associated renal artery atherosclerosis was slightly greater in the TA TEA group (58.3% versus 23.1%, p = 0.07) when compared to the AB group. Antegrade bypass was usually performed transabdominally (88.5%), while TA TEA was approached thoracoretroperitoneally (75.0%). Celiac revascularization was almost universal in both treatment groups, but the TA TEA group underwent significantly more frequent superior mesenteric artery (SMA) revascularization (93.8% versus 46.2%, p = 0.0001) and slightly more frequent inferior mesenteric repair (18.8% versus 3.8%, p = 0.07) than the AB group. In addition the frequency of combined renal and visceral repair (25.0% versus 0.0%, p = 0.01) as well as combined aortic, renal, and visceral repair (22.9% versus 3.8%, p = 0.03) was significantly greater in the TA TEA group. The obligatory interval of renal and visceral ischemia did not differ between the two approaches. The perioperative mortality rate was 12.2% and was the same for TA TEA (14.6%) and AB (7.7%). Overall the incidence of complications was the same with either operative approach, although patients in the TA TEA group tended to have multiple complications (17.1% versus 0.0, p = 0.03) and all significant pulmonary complications occurred in this group. Two patients were lost to follow-up. The cumulative percentage of patients who remained asymptomatic following AB or TA TEA was (respectively) 95.8% and 97.3% at 1 year and 86.5% and 86.1% at 5 years. Both of these operative approaches provide durable symptom relief with acceptable operative morbidity and mortality rates.(ABSTRACT TRUNCATED AT 400 WORDS)

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Research works printed but not linked: 2

  1. Crawford E. S., Morris G. C., Jr, Myhre H. O., Roehm J. O., Jr Celiac axis, superior mesenteric artery, and inferior mesenteric artery occlusion: surgical considerations. Surgery. 1977 Dec;82(6):856–866. [PubMed] [Google Scholar]
  2. Rogers D. M., Thompson J. E., Garrett W. V., Talkington C. M., Patman R. D. Mesenteric vascular problems. A 26-year experience. Ann Surg. 1982 May;195(5):554–565. doi: 10.1097/00000658-198205000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar] · DOI

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Authors
CUNNINGHAM, C. G., REILLY, L. M., RAPP, J. H., SCHNEIDER, P. A., & STONEY, R. J.
Affiliations
University of California, San Francisco (US)
ORCID
SCHNEIDER, PETER A.
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1991-09
Volume
214
Issue
3
Pages
276-288
ISSN
0003-4932 (ISSN-L)
DOI
10.1097/00000658-199109000-00010
PMC
PMC1358647
OpenAlex
W1501590777
Cited by
112
References
36
Citations by year
2026: 1 · 2021: 2 · 2019: 1 · 2017: 1 · 2016: 2 · 2015: 2 · 2013: 4 · 2012: 5
FWCI
3.53
Type
journal article
Language
en
Open access
Locations
  • Annals of Surgery (publishedVersion)
  • PubMed Central (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
renal artery atherosclerosis, perioperative mortality, postoperative complications, surgical approach comparison, preoperative weight loss
MeSH terms
Aged, Aorta, Abdominal, Aortic Diseases, Arteries, Arteriosclerosis, Digestive System, Endarterectomy, Female, Humans, Ischemia, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Vascular Surgical Procedures

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