Abstract
Purpose: Many authors have reported extended relief of intestinal ischemia by use of a variety of reconstructive techniques, but all have relied on symptomatic follow-up. None have objectively measured patency rates. The purpose of this study was to determine the primary patency rates of bypass grafts placed for acute and chronic splanchnic atherosclerotic occlusive disease with use of objective follow-up with mesenteric duplex ultrasound scanning or arteriography. Methods: Twenty-five consecutive patients (mean age 61, female/male ratio of 2.7:1) who underwent placement of 38 splanchnic bypass grafts (29 saphenous vein grafts, 9 polytetrafluoroethylene) (22 retrograde, 16 antegrade) for ischemic symptoms (9 acute ischemia: 16 chronic ischemia) between 1984 and 1994 were monitored with either duplex scanning (30 grafts) or arteriography. Life-table and log rank analysis were used to determine and compare graft patency. Results: Three patients (12%, 2 acute ischemia and 1 chronic ischemia) died after operation. Six patients (30%) had significant morbidity (4 acute ischemia and 2 chronic ischemia). During follow-up from 1 to 136 months (mean 35 months), no patient died of bowel infarction or required revision for recurrent symptoms. Objective testing revealed three graft occlusions. Symptomatic follow-up had a sensitivity of only 33% for graft occlusion when compared with objective measurement. The life-table primary patency rate was 89% at 72 months. Life-table survival for the same patients was 75% at 36 months. Patency rates for antegrade (93% at 36 months) versus retrograde (95% at 36 months) bypass and saphenous vein grafts (95% at 36 months) versus polytetrafluoroethylene (89% at 36 months) were not significantly different (p=0.47 and 0.43, respectively). Late patency rates of grafts placed for acute ischemia (92% at 36 months) versus chronic ischemia (89% at 36 months) were not significantly different (p=0.77). Conclusion: Splanchnic bypass for mesenteric ischemia, with a primary patency rate of 89% at 72 months, is an extremely durable form of revascularization. Long-term patency of grafts placed for acute ischemia does not differ significantly from that of bypasses for chronic occlusion. Duplex scanning allows standardized objective periodic follow-up of splanchnic reconstruction. Objective assessment is critical to accurately measure visceral revascularization patency rates.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 729-741 |
| Number of pages | 13 |
| Journal | Journal of Vascular Surgery |
| Volume | 21 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1995 |
Funding
Purpose: Many authors have reported extended relief of intestinal ischemia by use of a variety of reconstructive techniques, but all have relied on symptomatic follow-up. None have objectively measured patency rates. The purpose of this study was to determine the primary patency rates of bypass grafts placed for acute and chronic splanchnic atherosclerotic occlusive disease with use of objective follow-up with mesenteric duplex ultrasound scanning or arteriography. Methods: Twenty-five consecutive patients (mean age 61, female/male ratio of 2.7:1) who underwent placement of 38 splanchnic bypass grafts (29 saphenous vein grafts, 9 polytetrafluor0ethy!ene) (22 retrograde, 16 antegrade) for ischemic symptoms (9 acute ischemia: 16 Chronicischemia) between 1984 and 1994 were monitored with either duplex scanning (30 grafts) or arteriography. Life-table and log rank analysis were used to determine and compare graft patency. Results: Three patients (12%, 2 acute ischemia and 1 chronic ischemia) died after operation. Six patients (30%) had significant morbidity (4 acute ischemia and 2 chronic ischemia). During follow-up from i to 136 months (mean 35 months), no patient died of bowel infarction or required revision for recurrent symptoms. Objective testing revealed three graft occlusions. Symptomatic follow-up had a sensitivity of only 33% for graft occlusion when compared with objective measurement. The life-table primary patency rate was 89% at 72 months. Life-table survival for the same patients was 75% at 36 months. Patency rates for antegrade (93% at 36 months) versus retrograde (95% at 36 months) bypass and saphenous vein grafts (95 0 ~ at 36 months) versus polytetrafluoroethylene (89 0 at 36 months) were not significantly different (p = 0.47 and 0.43, respectively). Late patency rates of grafts placed for acute ischemia (92% at 36 months) versus chronic ischemia (89% at 36 months) were not significantly different (p = 0.77). Conclusion: Splanchnic bypass for mesenteric ischemia, with a primary patency rate of 89% at 72 months, is an extremely durable form of revascularization. Long-term patency of grafts placed for acute ischemia does not differ significantly from that of bypasses for chronic occlusion. Duplex scanning allows standardized objective periodic follow-up of splanchnic reconstruction. Objective assessment is critical to accurately measure visceral revascularization patency rates. (J VASe SURG 1995;21:729-41.) Symptomatic atherosclerotic disease of the mesenteric vessels remains a challenge for the vascular surgeon. Although first recognized as a clinical entity in 19181 and successfully treated surgically as early as From the Division of Vascular Surgery, Department of Surgery, McGaw Medical Center, Northwestern University Medical School, Chicago. Sponsored in part by the Agency for Health Care Policy and Research Grant RO1 HS07184-02. Reprint requests: Walter J. McCarthy, MD, Division of Vascular Surgery, 251 E. Chicago Ave., Chicago, IL 60611-2614. Copyright 9 I995 by The Society for Vascular Surgery and International Societyf or CardiovascularS urgery,N orth Ameri-can Chapter. 0741-5214/95/$3.00 + 0 24/6/63162 1958, 2 debate continues over the optimal operative approach, Improvements in surgical technique and perioperative intensive care have made long-term survival after mesenteric revascularization a reality. A variety of surgical techniques is used today including reimplantation, bypass grafting, transaortic endarterectomy, and patch angioplasty after endarterectomy. Over the past decade several reports have demonstrated the feasibility and excellent early results that are possible with each of these techniques, a~2 Many of these same reports examined symptomatic failure rates as the end point in subsets of patients in attempts to identify the potential benefits of particular approaches such as multiple vessel revas-
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery