Single Celiac-Superior Mesenteric Artery Bypass: An Alternative in Mesenteric Ischemia

Abstract

Operative reconstruction of the visceral vessels continues to have a high mortality rate. In this report, the authors describe a series of patients in whom a unique method of visceral reconstruction was employed. The single celiac-superior mesenteric artery (SMA) bypass, originating from and patching the celiac origin, and coursing to the SMA, is an effective way to revascularize both of these vessels. Fourteen mesenteric reconstructions performed in 12 patients (eight men and four women, mean age: 66 years) between 1989 and 1996 were reviewed. Eight patients had chronic intestinal ischemia (postprandial pain, mean weight loss 44 lb) for a mean duration of 11 months, and four patients had acute intestinal ischemia with peritonitis. Reconstructive procedures included seven single celiac-SMA bypasses; four bypasses from the aorta to the SMA, celiac artery, or both; one iliosuperior mesenteric bypass; and two visceral patch angioplasties. All single celiac-SMA bypasses remained patent; however, two of four antegrade aortomesenteric reconstructions failed within 24 hours. Operative time was shorter for single celiac-SMA bypasses than for other reconstructions (168 vs 231 min). Mortality rate was 25% (two of eight) in the patients with chronic ischemia, and 100% in those with acute ischemia. Long-term follow-up (15.5 months) in the six survivors operated on for chronic ischemia demonstrated resolution of symptoms in all. The single celiac-SMA bypass is an effective and expeditious method of visceral revascularization, with a short, straight graft. This technique requires two anastomoses instead of three, minimizes intraoperative intestinal ischemia, and is easily performed with prosthetic or autologous material.