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Titolo:
Elective surgical treatment of symptomatic chronic mesenteric occlusive disease: Early results and late outcomes
Autore:
Mateo, RB; OHara, PJ; Hertzer, NR; Mascha, EJ; Beven, EG; Krajewski, LP;
Indirizzi:
Cleveland Clin Fdn, Dept Vasc Surg, Cleveland, OH 44195 USA Cleveland ClinFdn Cleveland OH USA 44195 c Surg, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Biostat & Epidemiol, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 demiol, Cleveland, OH 44195 USA
Titolo Testata:
JOURNAL OF VASCULAR SURGERY
fascicolo: 5, volume: 29, anno: 1999,
pagine: 821 - 831
SICI:
0741-5214(199905)29:5<821:ESTOSC>2.0.ZU;2-6
Fonte:
ISI
Lingua:
ENG
Soggetto:
CHRONIC VISCERAL ISCHEMIA; CHRONIC INTESTINAL ISCHEMIA; ABDOMINAL ANGINA; REVASCULARIZATION; BYPASS; ARTERY; EXPERIENCE; MANAGEMENT; PROGRESS; STENOSIS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
38
Recensione:
Indirizzi per estratti:
Indirizzo: O'Hara, PJ ClevelandAClin Fdn, Dept Vasc Surg, 9500 Euclid Ave, Cleveland,OH 44195 US Cleveland Clin Fdn 9500 Euclid Ave Cleveland OH USA 44195 95 US
Citazione:
R.B. Mateo et al., "Elective surgical treatment of symptomatic chronic mesenteric occlusive disease: Early results and late outcomes", J VASC SURG, 29(5), 1999, pp. 821-831

Abstract

Purpose: The purpose of this study was to determine the safety and efficacy of the elective surgical treatment of symptomatic chronic mesenteric occlusive disease (SCMOD) and to identify the factors that influence the results of this procedure. Methods: From 1977 to 1997, 85 patients (mean age, 62 years) underwent elective surgical treatment of SCMOD. The presenting symptoms were abdominal pain in 78 patients (92%) and weight loss in 74 patients (87%). The surgicalprocedures included retrograde bypass grafting in 34 patients (40%), antegrade bypass grafting in 24 patients (28%), transaortic endarterectomy in 19patients (22%), local arterial endarterectomy with patch angioplasty in six patients (7%), thrombectomy alone in one patient (1%), and superior mesenteric artery reimplantation in one patient (1%). Thirty-five patients (41%)underwent concomitant aortic replacement. All the involved mesenteric vessels were revascularized in 21 patients (25%), whereas revascularization wasincomplete for the remaining 64 patients (75%). Late information was available for all 85 patients at a mean interval of 4.8 years. Results: There were seven early (<35 days) postoperative deaths (8%). The cumulative 5-year survival rate was 64% (95% confidence interval [CI], 53% to 75%), and the a-year symptom-free survival rate was 81% (95% CI, 72% to 90%). Serious complications occurred in 28 patients (33%). The results of univariate analysis identified advancing age at operation (P < .001), cardiac disease (P = .03), hypertension (P = .03), and additional occlusive disease (P = .05) as variables associated with mortality. Concomitant aortic replacement (P = .037), renal disease (P = .011), advancing age (P = .035), and complete revascularization (P = .032) were associated with postoperative morbidity including mortality. Late recurrent mesenteric occlusive disease was seen in 21 patients (16 symptomatic and five asymptomatic). Nine patients (43%) died, and 8 patients (38%) required subsequent surgical or endovascular procedures to treat their recurrent lesions. The 3-year survival ratefrom recurrent mesenteric occlusive disease was 76% (95% CI, 66% to 86%). Conclusion: We conclude that the elective surgical treatment of SCMOD may be performed with reasonable early and late mortality rates and that most of the patients remain free from recurrent symptoms of mesenteric ischemia. Advancing age, cardiac disease, hypertension, and additional occlusive disease significantly influenced the overall mortality rates, and concomitant aortic replacement, renal disease, and complete revascularization were significantly associated with postoperative morbidity rates. Surveillance and appropriate correction of recurrent disease appear to be necessary for optimal long-term results.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 01/04/20 alle ore 20:56:51