Open Surgical Bypass for Chronic Mesenteric Ischemia in the Era of Endovascular Surgery

Background: Chronic mesenteric ischemia (CMI) is a rare condition which affects up to 10% of the population over
65 years of age. The classical symptomology is a triad of postprandial abdominal pain, weight loss and/or unexplained
diarrhea. As expected, CMI has been treated extensively by endovascular interventions owing to the fewer in-hospital
complications and 30-day mortality rates. By reviewing the literature, some review articles showed better long-term
outcomes with primary and secondary patency rates being significantly higher for open repair.
Patients and Methods: This was a retrospective review of patients who underwent open surgical revascularization for
CMI at Alexandria University during the period between July 2013 and November 2021. Patients included were all older
than 18 years old and presented with CMI with documented weight loss and computed tomography (CTA) evidence of
atherosclerotic mesenteric occlusive disease. The primary endpoints were intra and postoperative complications.
Results: Nine cases of Ilio-mesenteric bypass were presented. The average age was 67 years, six out of nine were male
patients. Five patients had a Dacron graft used as the conduit for bypass and the rest had the great saphenous vein as the
chosen conduit. Two patients with a vein bypass had vein stenosis picked on CTA done for postoperative surveillance.
These were managed endovascularly, 1 patient had angioplasty and the other had veinoplasty and stenting. Another patient
had common iliac artery stenosis on follow-up CTA, this was managed by stenting. The minimum patency period was 3
years, 5 cases had graft occlusion at some point after 3 years and 4 cases had their grafts patent for 3, 7, 8, and 11 years.
Conclusion: Open surgical bypass for CMI still has a place in the era of endovascular surgery. It is safe and effective
even following the failed endovascular intervention. Clinical and radiological surveillance are both mandatory to ensure
long-term patency of the bypass.