Triple-vessel mesenteric ischaemia presenting with gastric ulceration
ABSTRACT We present an unusual presentation of chronic mesenteric ischaemia in a patient with recurrent gastric ulceration that highlights both the importance of recognition of ischaemia as a possible aetiology in those refractory to conventional treatment and the success of percutaneous transluminal mesenteric angioplasty in these cases.
Article: Mesenteric ischemia.New England Journal of Medicine 09/1982; 307(9):535-7. DOI:10.1056/NEJM198208263070905 · 54.42 Impact Factor
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ABSTRACT: The purpose of this study was to determine the safety and efficacy of the elective surgical treatment of symptomatic chronic mesenteric occlusive disease (SCMOD) and to identify the factors that influence the results of this procedure. From 1977 to 1997, 85 patients (mean age, 62 years) underwent elective surgical treatment of SCMOD. The presenting symptoms were abdominal pain in 78 patients (92%) and weight loss in 74 patients (87%). The surgical procedures included retrograde bypass grafting in 34 patients (40%), antegrade bypass grafting in 24 patients (28%), transaortic endarterectomy in 19 patients (22%), local arterial endarterectomy with patch angioplasty in six patients (7%), thrombectomy alone in one patient (1%), and superior mesenteric artery reimplantation in one patient (1%). Thirty-five patients (41%) underwent concomitant aortic replacement. All the involved mesenteric vessels were revascularized in 21 patients (25%), whereas revascularization was incomplete for the remaining 64 patients (75%). Late information was available for all 85 patients at a mean interval of 4.8 years. There were seven early (<35 days) postoperative deaths (8%). The cumulative 5-year survival rate was 64% (95% confidence interval [CI], 53% to 75%), and the 3-year symptom-free survival rate was 81% (95% CI, 72% to 90%). Serious complications occurred in 28 patients (33%). The results of univariate analysis identified advancing age at operation (P <.001), cardiac disease (P =.03), hypertension (P =.03), and additional occlusive disease (P =.05) as variables associated with mortality. Concomitant aortic replacement (P =.037), renal disease (P =.011), advancing age ( P =.035), and complete revascularization ( P =.032) were associated with postoperative morbidity including mortality. Late recurrent mesenteric occlusive disease was seen in 21 patients (16 symptomatic and five asymptomatic). Nine patients (43%) died, and 8 patients (38%) required subsequent surgical or endovascular procedures to treat their recurrent lesions. The 3-year survival rate from recurrent mesenteric occlusive disease was 76% (95% CI, 66% to 86%). We conclude that the elective surgical treatment of SCMOD may be performed with reasonable early and late mortality rates and that most of the patients remain free from recurrent symptoms of mesenteric ischemia. Advancing age, cardiac disease, hypertension, and additional occlusive disease significantly influenced the overall mortality rates, and concomitant aortic replacement, renal disease, and complete revascularization were significantly associated with postoperative morbidity rates. Surveillance and appropriate correction of recurrent disease appear to be necessary for optimal long-term results.Journal of Vascular Surgery 05/1999; 29(5):821-31; discussion 832. DOI:10.1016/S0741-5214(99)70209-0 · 2.98 Impact Factor
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ABSTRACT: Visceral artery surgery is well known to vascular surgeons, but most have limited personal experience. We report our experience with 90 patients treated for atherosclerotic lesions of the visceral arteries during a 25-year period 1968-1993. Retrospective study. Department of Vascular Surgery, University Hospital Rigshospitalet, Copenhagen, Denmark. 54 women and 36 men, aged 56 (median; range: 34-78 years) underwent 109 consecutive mesenteric reconstructions. The indication in 90 primary procedures was acute mesenteric ischaemia of non-embolic origin in 25 patients, chronic ischaemia in 53 and prophylactic reconstruction in connection with aortic surgery in 12 patients. The superior mesenteric artery (SMA) was revascularised in 87 patients and the coeliac axis or common hepatic artery in six. Thus, only three patients had both territories revascularised. Thromboendarterectomy was performed in 15 patients, transposition of the SMA directly into the infrarenal aorta in 30 and bypass in 48 patients. Cumulative symptom-free and survival rates. The overall perioperative (30 days) mortality rate was 13%, mainly caused by the high mortality rate of 44% (11 patients) in the acutely operated, as the mortality was 0% in patients operated on electively and only one out of 12 patients (8%) died after a prophylactic operation. Nine of the twelve deaths were due to progressive mesenteric infarction. Cumulated survival rates were 81, 60 and 35% after 5, 10 and 20 years, respectively which indicated a mortality rate three times that of an age- and sex-matched Danish population. During follow-up symptoms recurred in 30 patients, more often following emergency surgery and SMA transposition. Mesenteric revascularisation may yield long lasting results. However, surgery for acute ischaemia carries a high mortality rate, emphasising the importance of early surgery.European Journal of Vascular Surgery 06/1994; 8(3):297-302. DOI:10.1016/S0950-821X(05)80145-8