CELIAC AXIS, SUPERIOR MESENTERIC-ARTERY, AND INFERIOR MESENTERIC-ARTERY OCCLUSION - SURGICAL CONSIDERATIONS

Abstract

Occlusion of the celiac, superior mesenteric and inferior mesenteric arteries was studied in 46 patients treated by operation. The condition was acute and was caused by embolic obstruction of the superior mesenteric artery in 4 cardiac patients and detachment of the inferior mesenteric artery in 2 patients during removal of infrarenal abdominal aortic aneurysms. The condition was chronic and involved 2 or all 3 of the vessels in 40 patients. Embolic obstruction caused severe abdominal pain but few physical signs early in the process, but the picture of an acute abdomen indicating bowel gangrene developed in a few hours. Ischemia from inferior mesenteric detachment was observed at operation. Patients with chronic obstruction had abdominal pain, weight loss and diarrhea. Patients with embolic obstruction were treated successfully by embolectomy, and patients developing intraoperative sigmoid ischemia were treated by reattachment of inferior mesenteric arteries to aortic graft. Various procedures were employed in patients with chronic multiple obstruction. Graft bypass using Dacron tubing was preferable because of its simplicity and because the frequently (48%) associated occlusive disease and aneurysm of the distal aorta were treated at the same time. Confining operation to the abdomen significantly reduced the magnitude of operation and eliminated risks in this age group. Of the 46 patients, 91% survived and were relieved of their symptoms despite associated disease. The 5 yr survival rate in this group of patients was 62%.