Supraceliac aortomesenteric bypass for intestinal ischemia

• Published in: Journal of vascular surgery Vol. 5; no. 5; pp. 749 - 754
• Main Authors: Beebe, Hugh G., MacFarlane, Steven, Raker, Edmond J.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.1987; Elsevier
• Subjects: Aorta, Abdominal - diagnostic imaging; Aorta, Abdominal - surgery; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - surgery; Biological and medical sciences; Blood Vessel Prosthesis; Celiac Artery - diagnostic imaging; Celiac Artery - surgery; Chronic Disease; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Intestines - blood supply; Ischemia - diagnostic imaging; Ischemia - surgery; Male; Medical sciences; Mesenteric Arteries - diagnostic imaging; Mesenteric Arteries - surgery; Mesenteric Vascular Occlusion - diagnostic imaging; Mesenteric Vascular Occlusion - surgery; Methods; Middle Aged; Radiography; Saphenous Vein - transplantation; Human; Ischemia; Bypass; Surgery; Gut; Digestive diseases; Aortomesenteric; Abdominal blood vessel disease
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/0741-5214(87)90164-9

The supraceliac aorta has received little attention as an inflow site of bypass graft origin for mesenteric arterial reconstruction; this article describes our experience with its use in 10 patients. Ten patients underwent bypass grafts (three vein and seven prosthetic grafts) from the supraceliac aorta incorporating the celiac axis to the superior mesenteric artery. All patients had two- or three-vessel mesenteric arterial occlusion. No operative deaths occurred. Nine patients were studied with postoperative arteriography. Nine of ten patients have had satisfactory results on follow-up from 5 to 99 months (mean 43 months), although two patients required operative revision to achieve this. The operative technique is described, including approach to the aorta in the lower mediastinum via upper abdominal exposure and pancreatic displacement to expose the superior mesenteric artery. This method permits avoidance of the infrarenal aorta, if desired because of atherosclerotic disease or previous operation. Antegrade supraceliac aortomesenteric grafts avoid turbulence and compression of conventional “retrograde” bypass beneath the mesentery. We conclude that supraceliac aortic grafts provide a useful visceral artery reconstruction technique.