Axillomesenteric Bypass: A Series Of Seven Cases Of Unusual Mesenteric Revascularization At A Single Institution
Celso Dias, MD, Kevin Geary, MD, Nechelle Dias, Joseph Geary, MD, Patrick Riggs, MD.
Rochester General Hospital, Rochester, NY, USA.
OBJECTIVES: To report a series of seven cases of unusual mesenteric revascularization with extra-anatomic axillo-mesenteric bypass performed for mesenteric ischemia at a single institution and to study its efficacy and patency.METHODS: Axillo-mesenteric bypass cases performed at a single institution were collected retrospectively between 2016 and 2020 and data of the patient's clinical condition were collected through chart review and when possible at a clinic follow-up visit. Patency of the bypass graft was evaluated with duplex ultrasound and CT angiogram.RESULTS: A total of seven axillo-mesenteric bypass procedures were collected between 2016 and 2020. All cases were performed by extra-anatomic subcutaneous tunneling of PTFE graft with inflow from either the left or right axillary artery and entry distally into the abdomen in the subcostal region to bypass to the superior mesenteric artery. Five out of the seven cases were performed for acute mesenteric ischemia, one was performed for chronic mesenteric ischemia and one other for visceral de-branching for endovascular repair of type B aortic dissection that extended to the iliacs making it unsuitable for traditional inflow from the aorta or iliac arteries. Of the 5 procedures performed for acute mesenteric ischemia, 1 was following acute Type B dissection and 4 were for acute superior mesenteric artery occlusion with ischemic bowel requiring resection of the bowel, all of whom had highly calcified aorto-iliac occlusive disease. Three of the patients with ischemic bowel did poorly and succumbed to their poor general condition although the bypasses remained patent. All of the patients who were still alive had patent bypasses with one of them patent at 4 years follow-up.CONCLUSIONS: Axillo-mesenteric bypass is an unconventional but useful option of mesenteric revascularization in patients unsuitable for traditional open surgical or endovascular reconstruction.
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