Long-term outcome after mesenteric artery reconstruction: a 37-year experience

Abstract

Purpose: The purpose of this study was the definition of the late results and determining factors after mesenteric artery reconstruction (MAR) for atherosclerotic mesenteric ischemia.

Methods: A retrospective review identified 48 consecutive patients (66 arteries) who underwent MAR for acute mesenteric ischemia (AMI) of nonembolic origin (n = 23; 12 with and 11 without prior symptoms) and chronic mesenteric ischemia (CMI; n = 25) from 1963 to 2000 in a tertiary care referral center. The 29 women (60%) and the 19 men (40%) had a mean age of 64 years (range, 40 to 87 years). The operative procedures consisted of bypass grafting in 36 arteries (AMI, 12; CMI, 24), local endarterectomy (LEA) in 16 arteries (AMI, 9; CMI 7), and transaortic endarterectomy (TAE) in 14 arteries (AMI, 4; CMI, 10). The follow-up of the 34 survivors was complete in all but four patients and averaged 5.3 years (range, 30 days to 36 years). Radiographic documentation of vessel/graft patency was obtained in 33 of 34 survivors.

Results: Single-vessel revascularization was performed more frequently in the AMI group than in the CMI group (91% versus 48%; P =.001). The perioperative (<30 days) mortality rate in the AMI group was 52% (12 of 23 cases) as compared with 0 of 25 cases in the CMI group (P <.001). Bowel infarction was the cause of nine deaths. Major complications occurred in 60% of the cases. Fifteen late graft failures occurred, for a cumulative patency rate of 57% at 5 years and 46% at 10 years. TAE was associated with improved patency rates as compared with LEA (TAE versus LEA; P =.002). Symptomatic recurrences developed in eight patients, all involving superior mesenteric artery thrombosis (P <.001). The freedom-from-recurrence rates in the survivors were 79% at 5 years and 59% at 10 years. The late survival rates were 54% and 20% at 5 and 10 years, respectively. With the exclusion of perioperative deaths, the probability of long-term survival was 77% at 5 years and 29% at 10 years and did not differ between AMI and CMI.

Conclusion: Although MAR for CMI carries a low mortality rate, AMI remains a lethal and frequently unheralded problem. Long-term patency and symptom-free survival can be expected after successful MAR for AMI and is comparable with those rates achieved after MAR for CMI. The patency of the SMA is important in the prevention of symptomatic recurrences. Elective MAR is indicated in patients with CMI and warrants long-term surveillance.