title: The treatment of chronic intestinal ischemia.
abstract: OBJECTIVE
  Due to the rarity of the condition, large and prospective series defining the optimal method of digestive arteries revascularization, for the treatment of chronic intestinal ischemia, are lacking. The aim of this consecutive sample clinical study was to test the hypothesis that flexible application of different revascularization methods, according to individual cases, will yield the best results in the management of chronic intestinal ischemia.
  
  
  METHODS
  Eleven patients, of a mean age of 57 years, underwent revascularization of 11 digestive arteries for symptomatic chronic mesenteric occlusive disease. Eleven superior mesenteric arteries and one celiac axis were revascularized. The revascularization techniques included retrograde bypass grafting in 7 cases, antegrade bypass grafting in 2, percutaneous arterial angioplasty in 1, and arterial reimplantation in one case. The donor axis for either reimplantation or bypass grafting was the infrarenal aorta in 4 cases, an infrarenal Dacron graft in 4, and the celiac aorta in one case. Grafting materials included 5 polytetrafluoroethylene (PTFE) and 3 Dacron grafts. Concomitant procedures included 3 aorto-ilio-femoral grafts and one renal artery revascularization. Mean follow-up length was 31 months.
  
  
  RESULTS
  There was no operative mortality. Cumulative survival rate was 88.9% at 36 months (SE 12.1%). Primary patency rate was 90% at 36 months (SE 11.6%). The symptom free rate was 90% at 36 months (SE 11.6%).
  
  
  CONCLUSIONS
  Direct reimplantation, antegrade and retrograde bypass grafting, all allow good mid-term results: the choice of the optimal method depends on the anatomic and general patients status. Associated infrarenal and renal arterial lesions can be safely treated in the same time of digestive revascularization. Angioplasty alone yields poor results and should be limited to patients at poor risk for surgery.
authors.affiliation: Department of Surgery, Francesco Durante, University of Rome La Sapienza, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Illuminati
authors.forename: F G
authors.initials: FG
authors.lastname: Caliò
authors.forename: A
authors.initials: A
authors.lastname: D'Urso
authors.forename: V
authors.initials: V
authors.lastname: Papaspyropoulos
authors.forename: P
authors.initials: P
authors.lastname: Mancini
authors.forename: G
authors.initials: G
authors.lastname: Ceccanei
authors.forename: F
authors.initials: F
authors.lastname: Vietri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology