[Antegrade aortomesenteric revascularisation originating from the supracoeliac aortic segment--a promising surgical option in chronic ischaemia of the visceral arteries].
BACKGROUND
Ischaemia of the visceral arteries is considered to be an extraordinary challenge in the interdisciplinary therapeutic management.


OBJECTIVE
Using a case series of patients with chronic ischaemia of the visceral arteries, our diagnostic and therapeutic experience was analysed with regard to postoperative quality of life (increase of body weight, frequency in daily diarrhoea), perioperative morbidity and hospital mortality in dependence on the type of surgical reconstruction of the visceral arteries.


RESULTS
During a time period of 2 years, 3 patients (male/female=1:2; mean age, 61.7 years) underwent surgical interventions on the visceral arteries from a total of 1118 vascular interventions (main indication revealed by colonoscopy and pathohistology of mucosal biopsy: ischaemic colitis). In all cases, symptomatology was affected by abdominal angina. Duplex sonography, angiography, and multislice CT scan revealed the combination of an occlusion of the coeliac trunk and of the superior mesenteric artery by atherosclerosis in 2 cases. In the remaining case, there was an isolated occlusion at the origin of the superior mesenteric artery. For revascularisation, the aortomesenteric reconstruction was subdivided according to the: i) target vessel: -combination of revascularised common hepatic artery and superior mesenteric artery (n=1) with an autologous Y-vein bypass ("reversed technique"), -exclusive revascularisation of the superior mesenteric artery (n=2)-prosthetic bypass; ii) origin of the bypass: -from the supracoeliac aortic segment (antegrade) n=3 (primarily in patients 1 and 3; as a redo operation in patient 2); -from the infrarenal segment (retrograde) n=1 (initial surgical intervention in patient 2) using an autologous venous bypass. In all cases, a significant improvement of the quality of life was observed as indicated by an increase of body weight (n=3; +no further abdominal angina) and primary wound healing in all 3 cases (hospital mortality, 0).


CONCLUSIONS
Chronic ischaemia of the visceral arteries is characterised by an increasing incidence and a stealthy onset and requires an interdisciplinary approach to find the correct diagnosis using all available diagnostic procedures including sufficient periodic follow-up investigations. We favour the antegrade aortomesenteric revascularisation from the supracoeliac aortic segment as a promising surgical option in chronic ischaemia of visceral arteries.
Halloul
Z
Z
Gefässchirurgie, Klinik für Chirurgie, Universitätsklinikum, Magdeburg. Zuhir.Halloul@Medizin.Uni-Magdeburg.de
Eder
F
F
Wolff
S
S
Tautenhahn
J
J
Meyer
F
F
D000368:Aged; D000792:Angiography; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000601:surgery; D002908:Chronic Disease; D017091:Colitis, Ischemic / Q000000981:diagnostic imaging / Q000601:surgery*; D003106:Colon / Q000098:blood supply*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007421:Intestine, Small / Q000098:blood supply; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery*; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D014680:Veins / Q000637:transplantation