Retrograde mesenteric bypass with saphenous vein graft in chronic mesenteric ischemia in a resource-challenged setting
Introduction: Chronic mesenteric ischemia is a pathophysiologic condition arising due to demand–supply mismatch of blood supply to bowel postprandially, resulting in chronic abdominal pain, food fear, and weight loss. The most common cause is atherosclerosis. Timely intervention in the form of mesen...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2021-01-01
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| Series: | Indian Journal of Vascular and Endovascular Surgery |
| Subjects: | |
| Online Access: | http://www.indjvascsurg.org/article.asp?issn=0972-0820;year=2021;volume=8;issue=2;spage=139;epage=143;aulast=Sharma |
| _version_ | 1818954314204315648 |
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| author | Anil Sharma Sunil Dixit Sourabh Mittal Dhruva Sharma |
| author_facet | Anil Sharma Sunil Dixit Sourabh Mittal Dhruva Sharma |
| author_sort | Anil Sharma |
| collection | DOAJ |
| description | Introduction: Chronic mesenteric ischemia is a pathophysiologic condition arising due to demand–supply mismatch of blood supply to bowel postprandially, resulting in chronic abdominal pain, food fear, and weight loss. The most common cause is atherosclerosis. Timely intervention in the form of mesenteric revascularization is the key to successful outcome. There are limited contemporary data on in-hospital outcomes of mesenteric revascularization via open versus endovascular therapy in a resource-challenged setting. Materials and Methods: This retrospective-prospective observational study included eight patients of chronic mesenteric ischemia who underwent open revascularization and were followed for a mean duration of 15 months. All patients were evaluated as per the institutional protocol, and retrograde mesenteric bypass with reverse saphenous vein graft was done in all cases. Outcomes were evaluated in terms of resolution of symptoms and confirmation of graft patency with duplex scan after 1 month and every 6 months thereafter. Results: Out of 8 patients, six patients were males. Predisposing factors for atheromatous diseases were present in all. All patients presented with postprandial abdominal pain and weight loss. Majority of patients ( n = 5) had involvement of all three mesenteric vessels (superior mesenteric artery, inferior mesenteric artery, and celiac axis). One patient was re-explored for bleeding in immediate postoperative period. One patient was admitted for small bowel obstruction in 1st month of follow-up after surgery and was managed conservatively. Two patients were lost to follow-up and six patients are symptom free and doing well on a close follow-up of 15 months. Conclusion: Open mesenteric revascularization, by reverse saphenous vein graft as conduit for bypass, performed by experienced surgeon gives promising results in terms of symptom-free duration and graft patency and can be preferred over endoscopic revascularization as a viable option in resource-challenged settings in developing nations. |
| first_indexed | 2024-12-20T10:20:12Z |
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| id | doaj.art-a99aeb5d3d7a42909336495eed1eb40d |
| institution | Directory Open Access Journal |
| issn | 0972-0820 2394-0999 |
| language | English |
| last_indexed | 2024-12-20T10:20:12Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Vascular and Endovascular Surgery |
| spelling | doaj.art-a99aeb5d3d7a42909336495eed1eb40d2022-12-21T19:43:57ZengWolters Kluwer Medknow PublicationsIndian Journal of Vascular and Endovascular Surgery0972-08202394-09992021-01-018213914310.4103/ijves.ijves_93_20Retrograde mesenteric bypass with saphenous vein graft in chronic mesenteric ischemia in a resource-challenged settingAnil SharmaSunil DixitSourabh MittalDhruva SharmaIntroduction: Chronic mesenteric ischemia is a pathophysiologic condition arising due to demand–supply mismatch of blood supply to bowel postprandially, resulting in chronic abdominal pain, food fear, and weight loss. The most common cause is atherosclerosis. Timely intervention in the form of mesenteric revascularization is the key to successful outcome. There are limited contemporary data on in-hospital outcomes of mesenteric revascularization via open versus endovascular therapy in a resource-challenged setting. Materials and Methods: This retrospective-prospective observational study included eight patients of chronic mesenteric ischemia who underwent open revascularization and were followed for a mean duration of 15 months. All patients were evaluated as per the institutional protocol, and retrograde mesenteric bypass with reverse saphenous vein graft was done in all cases. Outcomes were evaluated in terms of resolution of symptoms and confirmation of graft patency with duplex scan after 1 month and every 6 months thereafter. Results: Out of 8 patients, six patients were males. Predisposing factors for atheromatous diseases were present in all. All patients presented with postprandial abdominal pain and weight loss. Majority of patients ( n = 5) had involvement of all three mesenteric vessels (superior mesenteric artery, inferior mesenteric artery, and celiac axis). One patient was re-explored for bleeding in immediate postoperative period. One patient was admitted for small bowel obstruction in 1st month of follow-up after surgery and was managed conservatively. Two patients were lost to follow-up and six patients are symptom free and doing well on a close follow-up of 15 months. Conclusion: Open mesenteric revascularization, by reverse saphenous vein graft as conduit for bypass, performed by experienced surgeon gives promising results in terms of symptom-free duration and graft patency and can be preferred over endoscopic revascularization as a viable option in resource-challenged settings in developing nations.http://www.indjvascsurg.org/article.asp?issn=0972-0820;year=2021;volume=8;issue=2;spage=139;epage=143;aulast=Sharmachronic mesenteric ischemiacomputed tomography aortogramendoscopic revascularizationopen revascularizationsaphenous vein |
| spellingShingle | Anil Sharma Sunil Dixit Sourabh Mittal Dhruva Sharma Retrograde mesenteric bypass with saphenous vein graft in chronic mesenteric ischemia in a resource-challenged setting Indian Journal of Vascular and Endovascular Surgery chronic mesenteric ischemia computed tomography aortogram endoscopic revascularization open revascularization saphenous vein |
| title | Retrograde mesenteric bypass with saphenous vein graft in chronic mesenteric ischemia in a resource-challenged setting |
| title_full | Retrograde mesenteric bypass with saphenous vein graft in chronic mesenteric ischemia in a resource-challenged setting |
| title_fullStr | Retrograde mesenteric bypass with saphenous vein graft in chronic mesenteric ischemia in a resource-challenged setting |
| title_full_unstemmed | Retrograde mesenteric bypass with saphenous vein graft in chronic mesenteric ischemia in a resource-challenged setting |
| title_short | Retrograde mesenteric bypass with saphenous vein graft in chronic mesenteric ischemia in a resource-challenged setting |
| title_sort | retrograde mesenteric bypass with saphenous vein graft in chronic mesenteric ischemia in a resource challenged setting |
| topic | chronic mesenteric ischemia computed tomography aortogram endoscopic revascularization open revascularization saphenous vein |
| url | http://www.indjvascsurg.org/article.asp?issn=0972-0820;year=2021;volume=8;issue=2;spage=139;epage=143;aulast=Sharma |
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