Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia

OBJECTIVE: Complete revascularization is recommended by many authors for treatment of intestinal ischemia. The observation that postprandial intestinal hyperemia is limited to the superior mesenteric artery (SMA) has suggested to us that SMA revascularization alone should be adequate treatment. We preferentially manage intestinal ischemia with a single bypass graft to the SMA and herein update our results using this approach. METHODS: Patients were identified from a prospectively established vascular surgical registry. Each patient was assessed for acute versus chronic intestinal ischemia, preoperative angiographic findings, operation used, perioperative morbidity and mortality, late symptomatic relief, cause of death, and life table-determined survival and graft patency. Graft patency was determined by follow-up angiography or duplex scanning. RESULTS: Fifty bypass grafts to the SMA alone were performed in 49 patients (31 women, 18 men; mean age, 62 years) for treatment of intestinal ischemia. In all patients additional splanchnic arteries were available for bypass grafting. Operative indications were acute symptoms in 21 patients, 14 of whom had bowel infarction; chronic symptoms in 26 patients; and prophylaxis in conjunction with infrarenal aortic surgery in 3 patients. Thirty-two grafts originated from the aorta or an iliac artery, and 18 originated from an aortic graft. There were 40 prosthetic and 10 autogenous conduits. Perioperative mortality was 3% in patients with chronic symptoms and 12% overall. All survivors were symptomatically improved. Mean follow-up was 44 months. Nine-year assisted primary graft patency was 79%, and 5-year patient survival was 61%. Two late deaths occurred in patients with recurrent intestinal ischemia resulting from graft occlusions. CONCLUSIONS: Bypass grafting to the SMA alone appears to be both an effective and durable procedure for treatment of intestinal ischemia. Our results appear equal to those reported for "complete" revascularization for intestinal ischemia. When the SMA is a suitable recipient vessel, multiple bypass grafts to other splanchnic vessels are unnecessary in the treatment of intestinal ischemia.     

The Surgical Treatment of Chronic Intestinal Ischemia: Results of a recent series

Due to the rarity of the condition, large and prospective series defining the optimal method of digestive arteries revascularization, for the treatment of chronic intestinal ischemia, are lacking. The aim of this consecutive sample clinical study was to test the hypotesis that flexible application of different revascularization methods, according to individual cases, will yield the best results in the management of chronic intestinal ischemia.

Eleven patients, of a mean age of 56 years, underwent revascularization of 11 digestive arteries for symptomatic chronic mesenteric occlusive disease. Eleven superior mesenteric arteries and one celiac axis were revascularized. The revascularization techniques included retrograde bypass grafting in 7 cases, antegrade bypass grafting in 2, percutaneous arterial angioplasty in 1, and arterial reimplantation in one case. The donor axis for either reimplantation or bypass grafting was the infrarenal aorta in 4 cases, an infrarenal Dacron graft in 4, and the celiac aorta in one case. Grafting materials included 5 polytetrafluoroethylene (PTFE) and 3 Dacron grafts. Concomitant procedures included 3 aorto-ilio-femoral grafts and one renal artery revascularization. Mean follow-up duration was 31 months.

There was no operative mortality. Cumulative survival rate was 88,9% at 36 months (SE 12,1%). Primary patency rate was 90% at 36 months (SE 11,6%). The symptom free rate was 90% at 36 months (SE 11.6%). Direct reimplantation, antegrade and retrograde bypass grafting, all allow good mid-term results: the choice of the optimal method depends on the anatomic and general patient’s status. Associated infrarenal and renal arterial lesions can be safely treated in the same time of digestive revascularization. Angioplasty alone yields poor results and should be limited to patients at poor risk for surgery.     

The surgical treatment of chronic intestinal ischemia: results of a recent series

Due to the rarity of the condition, large and prospective series defining the optimal method of digestive arteries revascularization, for the treatment of chronic intestinal ischemia, are lacking. The aim of this consecutive sample clinical study was to test the hypothesis that flexible application of different revascularization methods, according to individual cases, will yield the best results in the management of chronic intestinal ischemia. Eleven patients, of a mean age of 56 years, underwent revascularization of 11 digestive arteries for symptomatic chronic mesenteric occlusive disease. Eleven superior mesenteric arteries and one celiac axis were revascularized. The revascularization techniques included retrograde bypass grafting in 7 cases, antegrade bypass grafting in 2, percutaneous arterial angioplasty in 1, and arterial reimplantation in one case. The donor axis for either reimplantation or bypass grafting was the infrarenal aorta in 4 cases, an infrarenal Dacron graft in 4, and the celiac aorta in one case. Grafting materials included 5 polytetrafluoroethylene (PTFE) and 3 Dacron grafts. Concomitant procedures included 3 aorto-ilio-femoral grafts and one renal artery revascularization. Mean follow-up duration was 31 months. There was no operative mortality. Cumulative survival rate was 88.9% at 36 months (SE 12.1%). Primary patency rate was 90% at 36 months (SE 11.6%). The symptom free rate was 90% at 36 months (SE 11.6%). Direct reimplantation, antegrade and retrograde bypass grafting, all allow good mid-term results: the choice of the optimal method depends on the anatomic and general patient's status. Associated infrarenal and renal arterial lesions can be safely treated in the same time of digestive revascularization. Angioplasty alone yields poor results and should be limited to patients at poor risk for surgery.     

Use of the ascending aorta as bypass inflow for treatment of chronic intestinal ischemia

PURPOSE: Surgical revascularization of intestinal arteries is an effective long-term treatment for chronic intestinal ischemia (CII) regardless of the technique used. Conventional antegrade or retrograde bypass techniques are the most common modalities for extensive lesions that cannot be treated by endarterectomy or transposition. In this report, we describe our experience with an antegrade bypass technique from the ascending aorta in patients with no other available inflow. METHODS: From April 1990 to May 2004, we performed antegrade bypass from the ascending aorta to the celiac artery, superior mesenteric artery (SMA), or both in five patients. These cases accounted for 2.4% of the 211 patients who underwent surgery on intestinal arteries during the study period. Results: Four patients presented with symptomatic CII, and one patient had no intestinal ischemic symptoms. The underlying disease was Takayasu disease in two cases, Erdheim-Chester disease in one case, chronic aortic dissection in one case, and atherosclerosis in one case. Two patients had already undergone an unsuccessful revascularization attempt with another technique. Bypass was performed alone in three cases in association with revascularization of the ascending aorta, aortic arch, and proximal descending thoracic aorta in one case and in association with revascularization of the ascending aorta and proximal aortic arch and renal autotransplantation in one case. Recovery was uneventful in all cases. One venous graft occluded because of technical defects and required reoperation for prosthetic graft replacement on the 10th postoperative day. Symptoms of CII resolved in all cases. Four months after the procedure, one patient underwent dilatation of an asymptomatic stenosis of the SMA distal to the bypass. During the 50th month after the procedure, a new re-stenosis of the SMA appeared. Left untreated, this stenosis led to asymptomatic occlusion of the mesenteric segment of a sequential aortoceliomesenteric bypass 13 months later. This aortoceliac bypass and the other four bypasses were patent after 4, 31, 46, 52, and 120 months of follow-up. CONCLUSION: Antegrade intestinal artery bypass from the ascending aorta is an effective alternative for patients who have no other available inflow for conventional antegrade or retrograde bypass and for patients in whom major technical difficulties are likely after multiple exposures of the thoracoabdominal aorta. Although indications are uncommon, antegrade intestinal artery bypass can provide durable revascularization of the intestine.     

Surgical revascularization for chronic intestinal ischemia

AIM: The aim of this study was to assess outcome after surgical revascularization for chronic intestinal ischemia (CII). METHODS: From 1980 until 2003, 34 patients underwent revascularization for CII. Records were reviewed for operative technique, perioperative mortality and long-term outcomes. CII was diagnosed on the basis of clinical, arteriographic and angio-magnetic resonance imaging (MRI) criteria. Revascularization patency was monitored by arteriography, color duplex ultrasound scanning (CDS), computed tomography (CT)-scanning or angio-MRI. RESULTS: The celiac artery (CA) was severely diseased in 26 cases and the superior mesenteric artery (SMA) in 30 cases. Four patients presented single-vessel, 15 patients two-vessel, and 15 three-vessel involvement. Revascularization was performed by either simple (N=15) or double (N=19) bypass grafting. In 2 patients bypass grafting was combined with reimplantation. One patient underwent reimplantation alone. Median follow-up was 45 months. The 30-day mortality rate was 3%; there were 22 late death (64%). Primary revascularization patency was 94% at 1 month and 79.4% at 4 years. Clinical success rates were 85% and 70% respectively at 1 month and at 4 years. CONCLUSION: To choose the most suitable intervention, the Authors distinguished isolated CII treatable by single SMA revascularization from the digestive arteritis affecting the supramesocolic level of the abdomen, which requires double CA and SMA revascularization.     

Isolated inferior mesenteric artery revascularization for chronic visceral ischemia.

PURPOSE: Complete visceral artery revascularization is recommended for the treatment of chronic visceral ischemia. However, in rare cases, it may not be possible to revascularize either the celiac or superior mesenteric (SMA) arteries. We have managed a series of patients with isolated revascularization of the inferior mesenteric artery (IMA) and now report our experience gained over a period of three decades. METHODS: Records were reviewed from 11 patients with chronic visceral ischemia who underwent isolated IMA revascularization (n = 8) or who, because of failure of concomitant celiac or SMA repairs, were functionally left with an isolated IMA revascularization (n = 3). All the patients had symptomatic chronic visceral ischemia documented with arteriography. Five patients had recurrent visceral ischemia after failed visceral revascularization, and two patients had undergone resection of ischemic bowel. The celiac or the SMA was unsuitable for revascularization in five cases, and extensive adhesions precluded safe exposure of the celiac or the SMA in five cases. IMA revascularization techniques included: bypass grafting (n = 4), transaortic endarterectomy (n = 4), reimplantation (n = 2), and patch angioplasty (n = 1). RESULTS: There was one perioperative death, and the remaining 10 patients had cured or improved conditions at discharge. One IMA repair thrombosed acutely but was successfully revascularized at reoperation. The median follow-up period was 6 years (range, 1 month to 13 years). Two patients had recurrent symptoms develop despite patent IMA repairs and required subsequent visceral revascularization; interruption of collateral circulation by prior bowel resection may have contributed to recurrence in both patients. Objective follow-up examination with arteriography or duplex scanning was available for eight patients at least 1 year after IMA revascularization, and all underwent patent IMA repairs. There were no late deaths as a result of bowel infarction. CONCLUSION: Isolated IMA revascularization may be useful when revascularization of other major visceral arteries cannot be performed and a well-developed, intact IMA collateral circulation is present. In this select subset of patients with chronic visceral ischemia, isolated IMA revascularization can achieve relief of symptoms and may be a lifesaving procedure.     

Endovascular treatment of celiac and mesenteric arteries stenoses: applications and results

PURPOSE: To evaluate the safety and assess the role of endovascular therapy in a variety of conditions related to celiac and mesenteric vascular occlusive disease.Patients and methods Our retrospective study population included 25 consecutive patients (mean age, 66 years), in whom 28 procedures were performed on 26 stenosed or occluded mesenteric vessels (superior mesenteric artery [SMA] or celiac artery [CA]). Indications included chronic mesenteric ischemia (21 patients), including 2 patients who underwent stenting prior to a planned operative repair of a juxtamesenteric AAA. Three liver transplantation patients underwent stenting of an associated CA stenosis. One patient with a splenorenal bypass underwent stenting on an associated CA stenosis. The technical and clinical success rates and the incidence of complications were determined. Follow-up parameters included maintained patency on duplex sonography and sustained clinical benefit. The need for additional interventions was noted. RESULTS: All procedures but one were technically successful (96%). Major complications occurred in three patients (one transient contrast-induced nephrotoxicity and two pseudoaneurysms). Immediate clinical success was achieved in 22 patients (88%). The three clinical failures included two patients with an excellent angiographic outcome, but with single-vessel moderate severity disease. Survival table analysis of delayed clinical outcome showed primary and primary-assisted clinical benefits at 11 months of 85% and 91%, respectively. Primary and primary-assisted stent patencies, as assessed by duplex sonography and/or angiography, at 6 months were both 92%. Angiographically documented restenosis occurred in three patients. Restenosis in two patients with CA stents was due to extrinsic compression, and it was without symptoms in one patient and was treated satisfactorily by restenting in the other patient. Restenosis in one patient with an SMA stent was successfully treated by restenting. CONCLUSIONS: Our experience suggests a potential role for endovascular therapy of celiac and mesenteric arterial occlusive disease in a variety of clinical scenarios, with a low incidence of complications and a high technical success rate.     

Ulzerierende, ischämische Gastritis

Ischemic ulcerative gastritis caused by mesenteric artery insufficiency is rare because of the high collateral blood flow between the celiac trunk and the superior mesenteric artery (SMA). Nearly 50% of patients with ischemic gastritis have been treated for an ulcerative pathology prior to revascularization. The diagnosis should be considered in cases of occlusive atherosclerotic disease, previous surgery for acute or chronic intestinal ischemia and heavy smokers. The SMA is the predominant artery in chronic visceral ischemia and should be revascularized first. In cases of isolated supramesocolic ischemia celiac trunk revascularization should be considered as a priority. We report about a patient with ischemic ulcerative gastritis and ischemic colitis which could be successfully treated by endarterectomy of the infrarenal aorta and an aortomesenteric bypass.     

Distal thoracic aorta as inflow for the treatment of chronic mesenteric ischemia

PURPOSE: Mesenteric revascularization for chronic mesenteric ischemia (CMI) traditionally involves antegrade or retrograde bypass graft originating from the supraceliac or infrarenal aorta. The distal thoracic aorta (DTA) may provide a better inflow source than the abdominal aorta. The purpose of this study was to evaluate the results with the DTA used as inflow for the surgical treatment of CMI. METHODS: All patients undergoing mesenteric revascularization for CMI with grafts originating from the DTA were identified from 1990 to 1999. A ninth interspace thoracoretroperitoneal incision was used for exposure, and distal aortic flow was maintained by use of a partial occlusion clamp. RESULTS: Eighteen consecutive patients with CMI underwent mesenteric bypass grafting with the DTA used as inflow. All patients were admitted with chronic abdominal pain or weight loss, with two (12%) requiring urgent revascularization because of acute exacerbation of chronic symptoms. Fourteen (78%) patients had both celiac and superior mesenteric artery bypass grafts placed, and three (17%) patients had superior mesenteric artery grafts alone. There was one (6%) perioperative death and three (17%) major complications. There was no kidney failure, mesenteric infarction, or spinal cord ischemia. The life-table survival rate was 89%, 89%, and 76% at 1, 3, and 5 years, respectively. All 18 patients remained symptom free and required no additional procedures to assist patency. There was no evidence of graft stenosis or occlusion (100% patency) for those grafts evaluated objectively during the mean follow-up of 34.8 months (range, 1-97 months). CONCLUSIONS: Antegrade mesenteric revascularization with the DTA used as inflow is associated with low morbidity and mortality rates. Furthermore, it provides excellent midterm patency and survival results and should be considered as a primary approach for reconstruction of patients with CMI.     

Mesenteric vascular problems. A 26-year experience.

Mesenteric vascular problems are infrequent, but may be catastrophic. During a 26-year period, 55 private patients were treated for the following disorders: (1) 12 patients with visceral artery aneurysms, (2) 8 with celiac compression syndrome, (3) 13 with chronic mesenteric ischemia, (4) 12 with acute mesenteric ischemia, and (5) 10 with mesenteric ischemia associated with aortic reconstructions. Splenic artery aneurysms were managed by excision and splenectomy, while celiac and hepatic had excision with graft replacement. Patients with celiac compression syndrome underwent lysis of the celiac artery. Two patients had compression of both celiac and superior mesenteric artery (SMA). One patient required vascular reconstruction of both arteries for residual stenoses. Patients having chronic mesenteric ischemia were treated with bypass grafts, with one death (7.7% mortality) and good long-term results. Those with acute mesenteric ischemia were treated by SMA embolectomy, bowel resection, or both, with a mortality of 67%. When associated with aortic reconstructions, mesenteric ischemia carried a mortality of 100% if bowel infarction occurred after operation, but when prophylactic mesenteric revascularization was performed at the time of aortic surgery, prognosis was greatly improved, with only one death among six patients. An aggressive approach including prompt arteriography with early diagnosis and surgical therapy is advocated for these catastrophic acute mesenteric problems.     

Long-Term Results of Aorta-Superior Mesenteric Artery Bypass Using a New Route

Purpose Several methods of revascularization after mesenteric ischemia have been proposed. Using a new route, we performed retrograde loop bypass grafting to the superior mesenteric artery (SMA) with a ringed expanded polytetrafluoroethylene (ePTFE) graft.Methods We anastomosed the graft to the infrarenal aorta, which ran behind the left renal hilum, turned ventral, and was anastomosed to the SMA in an antegrade fashion hemodynamically. Five patients underwent this procedure, which resulted in remarkable symptomatic relief.Results There were no postoperative deaths or serious complications, although some patients suffered paralytic ileus. All of the grafts remained patent during long-term follow-up, ranging from 17 to 72 months (mean: 37.8 months). Postoperative angiograms showed good configuration of the graft, which did not compress the renal vessels.Conclusion Infrarenal aorta-SMA bypass relieved mesenteric ischemia and achieved good long-term graft patency. Thus, we consider it to be an effective and durable vascular procedure to reduce postoperative mortality and morbidity.     

Long-term results of the surgical management of symptomatic chronic intestinal ischemia.

We analyzed our surgical experience in 20 patients who underwent revascularization procedures for symptomatic chronic intestinal ischemia caused by atherosclerosis. The group comprised 17 women and 3 men, with an age range of 25 to 71 years (mean 58.6 years). Sixteen patients had postprandial abdominal pain, and 4 had pain not related to eating. The average weight loss was 23.8 lb. Malabsorption and diarrhea were present in 8 patients. The duration of the symptoms was from 4 to 46 months (mean 13.4 months). One patient presented with acute intestinal ischemia following balloon angioplasty reocclusion of a stenotic celiac artery, and 3 underwent surgery for stenosis of a previously placed graft. Five patients had single mesenteric artery involvement, 10 had double-artery involvement, and 5 had significant occlusion in all 3 mesenteric arteries. The major arteries were revascularized whenever technically possible; therefore, 36 arteries were revascularized in 20 patients. Bypass grafts were done in 27 vessels, reimplantation in 7, and endarterectomy with patch angioplasty in 2. The saphenous vein was used in 12 vessels, polytetrafluoroethylene grafts in 8, dacron in 6, and inferior mesenteric vein in 1. The type of revascularization or graft utilized did not affect long-term patency. Two patients had early graft thrombosis and required intestinal resection. All patients survived the operation. At a mean follow-up of 36 months, all 20 patients were alive and asymptomatic with regard to their abdominal complaint. Ten patients (50%) underwent postoperative abdominal angiography; all the grafts were patent.(ABSTRACT TRUNCATED AT 250 WORDS)     

Superior mesenteric artery-to-renal artery bypass: A rare but useful alternative for renal artery revascularization

The aorta, celiac axis, and iliac arteries are the most common inflow arteries used for renal revascularization. When these inflow vessels are diseased, the superior mesenteric artery (SMA) can be an alternative source of renal artery graft inflow. Previous reports have suggested that only an enlarged SMA should be used for this purpose, for fear of developing mesenteric ischemia. We report a patient who required renal artery revascularization with a saphenous vein graft from a normal-caliber SMA who did not develop subsequent mesenteric ischemia. The procedure was unique in demonstrating that the SMA can be used as a viable source of graft inflow even when it is anatomically normal.     

Treatment of acute type B aortic dissection with organ ischemia

Nine patients, who suffered from acute type B aortic dissection with organ ischemia, were treated at our hospital from 2004 to 2006. Their mean age was 60.3 (range 37-73) years. Eight of them required surgical intervention. Two patients with mesenteric-ischemia underwent superior mesenteric artery (SMA) bypass surgery and their conditions were relieved. However, 1 of them died of aortic rupture 6 months later. One patient with celiac artery occlusion was at first treated nonsurgically, but was subjected to resection of the small intestine 3 weeks later because of ulcer perforation induced by ischemia. The other 5 patients with lower extremity ischemia underwent bypass surgery and were discharged. Bypass surgery is a reliable procedure for the treatment of acute type B aortic dissection with organ ischemia, allowing prompt resolution of ischemia.     

Role of supraceliac aortic bypass in visceral artery reconstruction.

Twelve patients underwent transabdominal, supraceliac aortomesenteric bypass for celiac and superior mesenteric artery occlusive disease. Nine patients had bypass for intestinal ischemia (five acute, four chronic), and one patient each had bypass for arcuate ligament syndrome, thoracoabdominal aneurysm, and an infected aortic stump "blowout." Three aortoceliac, 9 aortohepatic, and 10 aortosuperior mesenteric artery bypasses were performed. Prosthetic grafts were used for the bypasses in 11 of the 12 patients. One death occurred in a patient with preexisting hepatic necrosis and renal failure secondary to acute mesenteric ischemia. During a mean follow-up of 26 months, one graft thrombosis occurred and required revision for recurrent symptoms. Supraceliac aortomesenteric bypass appears to be a safe and effective procedure for visceral revascularization.     

Piggy-back mesenteric arterial reconstruction.

Reimplantation of stenotic or occluded visceral arteries into the aorta is one solution to symptomatic chronic visceral ischemia. We report a patient in whom the associated problem of small bowel infarction precluded prosthetic reconstruction and saphenous vein was unavailable. Reimplantation of the celiac artery into the aorta was combined with piggy-back reimplantation of the superior mesenteric artery into the side of the celiac artery to provide successful revascularization of the small bowel. A 16-month angiographic and 5-year clinical follow-up is provided.     

Open surgery for atherosclerotic chronic mesenteric ischemia

BACKGROUND: This study was undertaken to document the results of our current practice of open mesenteric revascularization to enable comparison with the recent trend of percutaneous endovascular therapy for the treatment of chronic mesenteric ischemia. METHODS: Patients were identified via operation code data as well ongoing audit data from 1992 until 2006. Only patients with a history of chronic mesenteric ischemia secondary to atherosclerosis for 3 months or longer were included in the study. Follow-up data have been collected prospectively and include clinical examination and history, as well as graft surveillance consisting of mesenteric duplex ultrasonography, computed tomography, and/or angiography every 6 months for 3 years and then yearly thereafter. RESULTS: Thirty-nine consecutive patients underwent 41 open revascularization procedures for chronic mesenteric ischemia, comprising 67 bypass grafts. The mean patient age was 65 years (range, 45-85 years), and 44% (n = 17) were male. Symptoms were present on average for 11 months (range, 4-48 months) before treatment. The average weight loss was 11.4 kg, and three patients (7.6%) also had evidence of ischemic enteritis. There was one perioperative death, thus giving a perioperative mortality rate of 2.5%. Perioperative morbidity occurred in five patients (12.2%). Primary graft patency was 92% at 5 years. Seven patients died during follow-up, which ranged from 4 to 161 months (mean, 39 months)-one (2.5%) from mesenteric ischemia. Two (5%) other patients have had recurrent mesenteric ischemic symptoms. CONCLUSIONS: Open surgical mesenteric revascularization by bypass grafting for atherosclerotic-induced chronic mesenteric ischemia can be performed with low mortality and morbidity and provides excellent long-term primary patency rates and symptom-free outcomes. Pending more data on the acute and long-term results of endovascular techniques, open mesenteric revascularization remains the gold standard for most patients with chronic mesenteric ischemia.     

Management of pediatric visceral arterial and aortic coarctation

Two unusual pediatric vascular problems have been managed surgically. The first patient is a five-and-a half-year old girl who presented with renal artery stenosis and aneurysm and renovascular hypertension. This was treated by excision of the aneurysm and reimplantation of the right renal artery. The second patient is a two-year old girl with atresia of the abdominal aorta, superior mesenteric artery (SMA) and both renal arteries. She was treated by PTFE patch graft angioplasty of the aorta, SMA reimplantation and bilateral aorto-renal autogenous saphenous vein bypass.     

Is distal anastomosis only to the true channel in chronic type B aortic dissection justified?

BACKGROUND: We investigated long-term outcomes of the distal false lumen of the aorta and aortic branches after distal anastomosis of the graft only to the true lumen in chronic type B aortic dissection. METHODS: From November 1979 until June 1998, we treated 98 patients without Marfan syndrome who had chronic type B aortic dissection and underwent replacement of the descending aorta, 79 of whom had distal anastomosis to the true lumen only. The celiac artery originated from the false lumen in 11 patients, superior mesenteric artery in 5, right renal artery in 19, and left renal artery in 16. RESULTS: There were 12 (15.1%) early deaths. Spinal cord ischemia was detected in 5 patients. Postoperative follow-up was achieved in 67 patients, and 13 patients died. Postoperative survival at 10 years was 67.6% +/- 7.1%. Eight patients had complete occlusion of the distal false lumen, 54 patients had occlusion of the false lumen down to the celiac artery, and 5 patients had a patent false lumen. Four patients required further replacement of the thoracoabdominal aorta. CONCLUSIONS: In non-Marfan patients with chronic type B aortic dissection, the false lumen distal to the graft anastomosis was likely to be thrombosed when the graft was anastomosed to the true lumen only. Postoperative visceral circulation was not compromised, but spinal cord ischemia is a problem that remains to be solved.     

MSCTA观察腹腔干与肠系膜上动脉的解剖学变异

目的采用MSCTA评价腹腔干与肠系膜上动脉及其主要分支的解剖变异。方法收集1000例患者的MSCTA,进行VR、MIP和MPR,观察腹腔干与肠系膜上动脉及其主要分支的起源和走行。结果1000例患者中,880例（88．00％）属于正常解剖学类型（Michels I型）,120例（12．00％）存在不同类型的解剖变异,其中72例（7．20％）属于Mi-chelsⅡ～X型;48例（4．80％）不属于Michels分型,包括腹腔干-肠系膜上动脉共干31例（3．10％）,脾动脉起源于肠系膜上动脉5例（O．50％）,胃十二指肠动脉起源于肠系膜上动脉和脾动脉各3例（O．30％）、肝左动脉1例（O．10％）,腹腔干缺如2例（O．20％）,胃左动脉起源于腹主动脉、脾动脉和肝固有动脉各1例（O．10％）。结论腹腔干与肠系膜上动脉存在广泛的解剖学变异;MSCTA有助于了解变异情况,对腹部血管外科手术具有指导意义。