Chronic mesenteric ischemia

Thirty-four patients (twelve men, 22 women, mean age 53[16-71] years) with chronic mesenteric ischaemia were operated upon between 1979 and 1992. The most frequent symptom was loss of weight (50%) and postprandial pain (44%). The mean interval between onset of symptoms and diagnosis was 35 months. Angiography revealed disease of the coeliac trunk (CT) or the superior mesenteric artery (SMA) in 16 patients, of only the SMA in ten, and of only the CT in eight. Revascularisation was obtained with an autologous vein graft in 21 patients (on the TC in 12, AMS in nine), while transaortic endarterectomy was performed in 15 (on the CT in seven, the AMS in nine). There was one perioperative death. 20 patients were symptom-free 1-126 months after the operation, while five still had residual symptoms even though improved in three. Seven patients had a recurrence of symptoms, three immediately after operation and four after an initial symptom-free period. These results show that freedom from symptoms can be achieved even in advanced stages of chronic mesenteric ischaemia by reconstructive surgery of the intestinal and visceral arteries. However, residual symptoms that are possibly not of a vascular nature may persist after successful vascular reconstruction. Patients with recurrent obstruction may become symptom-free by repeat surgery even many years later.