Surgical revascularization for chronic intestinal ischemia.
OBJECTIVE
The aim of this study was to assess outcome after surgical revascularization for chronic intestinal ischemia (CII).


METHODS
From 1980 until 2003, 34 patients underwent revascularization for CII. Records were reviewed for operative technique, perioperative mortality and long-term outcomes. CII was diagnosed on the basis of clinical, arteriographic and angio-magnetic resonance imaging (MRI) criteria. Revascularization patency was monitored by arteriography, color duplex ultrasound scanning (CDS), computed tomography (CT)-scanning or angio-MRI.


RESULTS
The celiac artery (CA) was severely diseased in 26 cases and the superior mesenteric artery (SMA) in 30 cases. Four patients presented single-vessel, 15 patients two-vessel, and 15 three-vessel involvement. Revascularization was performed by either simple (N=15) or double (N=19) bypass grafting. In 2 patients bypass grafting was combined with reimplantation. One patient underwent reimplantation alone. Median follow-up was 45 months. The 30-day mortality rate was 3%; there were 22 late death (64%). Primary revascularization patency was 94% at 1 month and 79.4% at 4 years. Clinical success rates were 85% and 70% respectively at 1 month and at 4 years.


CONCLUSIONS
To choose the most suitable intervention, the Authors distinguished isolated CII treatable by single SMA revascularization from the digestive arteritis affecting the supramesocolic level of the abdomen, which requires double CA and SMA revascularization.
Zerbib
P
P
Department of General and Vascular Surgery, University Hospital of Lille, Lille, France. p-zerbib@chru-lille.fr
Khoury-Helou
A
A
Lebuffe
G
G
Massouille
D
D
Nunes
B
B
Chambon
J P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D002445:Celiac Artery / Q000601:surgery*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007422:Intestines / Q000098:blood supply* / Q000000981:diagnostic imaging; D007511:Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery*; D008875:Middle Aged; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome