Peripheral Vascular Surgery Society

Purpose: Revascularization for chronic mesenteric ischemia is an infrequent vascular procedure whose objective long-term patency results have been described in only a limited number of reports comprised of small numbers of patients. We reviewed our experience with such procedures and report on the objective and symptomatic long-term results.

Patients: We retrospectively reviewed a consecutive series of 42 patients who underwent mesenteric arterial reconstruction of 66 vessels during an eleven-year period from 1986 to 1997. All patients were treated for symptomatic chronic mesenteric ischemia. There were 30 (69%) females and 12 (31%) males, with a mean age of 60 ± 2 years. The 66 visceral vessel reconstructions included 42 (63%) prosthetic and 15 (36%) autologous vein grafts. Objective follow-up was based on postoperative duplex or angiographic studies. Symptomatic long-term relief was assessed by telephone survey.

Results: The perioperative mortality rate was 10%, while major morbidity was incurred by 30% of patients. Life-table analysis demonstrated significantly better primary bypass patency rates of 89% for prosthetic grafts and 49% for autologous vein reconstructions at three years [p<0.05]. Long-term survival was 80% at 5 years. Three-quarters of surviving patients were contacted at an average of three years after surgery. Almost all surviving patients (96%) were free of postprandial abdominal pain. With a mean postoperative weight gain of 20 ± 9 lb.

Conclusions: These results support the clinical efficacy and durability of visceral artery bypass procedures for patients with symptomatic chronic mesenteric ischemia. In our experience, patency rates for prosthetic reconstructions were higher than those utilizing autologous vein.