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• W2947593399 abstract "Acute mesenteric ischemia is associated with extremely high morbidity and mortality rates. Open revascularization has been considered the “gold standard” treatment; however, there have been concerns about supraceliac clamping in potentially unstable patients as well as patency rates for iliac-based bypasses. The purpose of this study was to compare outcomes for antegrade and retrograde mesenteric bypass configurations in acute mesenteric ischemia. The registry of a single vascular group was queried for bypasses performed for acute mesenteric ischemia. Demographics, operative details, and perioperative and long-term outcomes were recorded and compared using χ2 analysis, Fisher exact test, t-test, and log-rank analysis. There were 53 patients identified who underwent open reconstruction for acute mesenteric ischemia from 2007 to 2017. There were 34 patients who underwent aorta to superior mesenteric artery/common hepatic bypass (antegrade) and 19 who underwent iliac to superior mesenteric artery bypass (retrograde) and were followed up for a mean of 15 months (range, 1-99 months). Demographics and comorbidities, such as hypertension, hypercholesterolemia, coronary disease, tobacco use, diabetes, and renal failure, were similar among the patients. The study included a sex split of 20 male and 23 female patients; 46 bypasses were performed with polytetrafluoroethylene, and 7 bypasses used excised vein as conduit. Operative blood loss was similar between groups (antegrade range, 100-2000 mL; retrograde range, 50-800 mL; P = .664). Perioperative complications were similar between groups and included pulmonary failure, sepsis, abdominal compartment syndrome, bowel ischemia, and myocardial infarction. Five (26.3%) retrograde patients had an attempt at supraceliac clamping; however, technical difficulties secondary to calcific disease led to use of the iliac artery as inflow. Bowel resection rates were similar between groups (antegrade, 20.58%; retrograde, 12.63%; P = 1.0). Perioperative mortality rates were similar (11.32% antegrade vs 9.47% retrograde; P = .378). The 1-year survival rates were similar for antegrade and retrograde (59% vs 42%; P = .247). All bypasses were patent in survivors at 1 year (P = 1.0). Acute mesenteric ischemia is associated with very high mortality rates, and open bypass remains the treatment standard. Bypasses using supraceliac aorta as inflow appear to offer perioperative mortality rates equivalent to those of their iliac-based counterparts. In terms of patency, iliac-based bypasses offered similar outcomes to aorta-based bypasses." @default.
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• W2947593399 date "2019-06-01" @default.
• W2947593399 modified "2023-09-26" @default.
• W2947593399 title "SS13. Bypass Configuration Outcomes for Acute Mesenteric Ischemia" @default.
• W2947593399 doi "https://doi.org/10.1016/j.jvs.2019.04.270" @default.
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