Simultaneous aortic surgery and malnutrition increase morbidity after revascularisation of the mesenteric arteries.
OBJECTIVE
To evaluate the early and late outcome of mesenteric revascularisation in patients who had had elective mesenteric revascularisation for chronic intestinal ischaemia.


METHODS
Retrospective review.


METHODS
Academic clinic, United States.


METHODS
19 consecutive patients (7 men, 12 women; mean age 70 years, range 53-83).


RESULTS
Angiography showed that 2 mesenteric vessels were affected in 7 patients and 3 in 12. Four patients had coexisting symptomatic aortoiliac occlusive disease and 1 patient had bilateral renal artery stenosis. A total of 36 visceral arteries were revascularised. One patient died postoperatively, and 8 developed serious complications. Morbidity and mortality were significantly higher in patients who had simultaneous infrarenal aortic or renal artery reconstructions (p = 0.01). Patients whose body weight before operation was less than 90% of ideal had more complications (8/11) than patients who were within 10% of their ideal body weight (1/8) (p = 0.02). Cumulative survival was 89% at 1 year, 72% at 3 years, and 57% at 5 years. The cumulative graft patency rate was 92% at 3 years and 66% at 5 years.


CONCLUSIONS
Mesenteric bypass procedures for chronic mesenteric ischaemia are durable. Long-term survival and graft patency rates are excellent even in older patients. Simultaneous aortic surgery should be avoided because of the associated morbidity. More than 10% below ideal body weight was associated with higher morbidity. For these patients, early total parenteral nutrition postoperatively, or a period of total parenteral nutrition preoperatively may reduce postoperative morbidity and mortality.
Seelig
M H
MH
Department of Surgery, General Hospital Ludwigshafen, Germany.
Klingler
P J
PJ
Oldenburg
W A
WA
D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002908:Chronic Disease; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000209:etiology / Q000601:surgery*; D015993:Life Tables; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000601:surgery*; D008875:Middle Aged; D009748:Nutrition Disorders / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality