IS OPEN SURGICAL REVASCULARIZATION STILL AN OPTION FOR TREATING CHRONIC MESENTERIC ISCHEMIA?

Abstract

Chronic mesenteric ischemia (CMI) is a condition caused by inadequate blood supply to the gastrointestinal tract for at least 3 months due to atherosclerosis. Materials and methods: Diagnosis is often delayed until the patient is referred to a vascular surgery unit. In patients requiring revascularization for CMI, the superior mesenteric artery (SMA) is the primary target vessel using either open or endovascular (EV) techniques. While EV therapy has become the first-line treatment, open surgical re-vascularization remains relevant for selected cases. The revascularization procedure consists of aortomesenteric bypass reconstructing the visceral arteries. Results: This paper presents six consecutive cases of CMI treated at the Vascular Surgery Unit of the “Sf. Spiridon” County Clinical Emergency Hospital, Iasi, Romania, between 2014 and 2024. All patients had symptoms suggestive of mesenteric disease, two cases were associated with aorto-iliac disease, one case had thromboangiitis obliterans. CT angiography revealed stenotic or occlusive lesions in the celiac trunk and mesenteric arteries in five cases and a fusiform partial thrombosed aneurysm of the SMA in one case. Surgically revascularized mesenteric arteries were SMA and IMA in one case and SMA in four cases. Venous grafts were used for revascularization in three cases and synthetic grafts in two cases. EV treatment consisted of double stenting of the SMA in one case. Primary patency in the surgical group was 60%, and secondary patency was 100%. Symptomatic resolution was observed in all cases. Conclusions: Open surgical revascularization remains an important option, especially for patients with extensive mesenteric artery disease.