Outcomes of reoperative open or endovascular interventions to treat patients with failing open mesenteric reconstructions for mesenteric ischemia Karina.

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Presentation transcript:

Outcomes of reoperative open or endovascular interventions to treat patients with failing open mesenteric reconstructions for mesenteric ischemia Karina S. Kanamori, MD, Gustavo S. Oderich, MD, Javairiah Fatima, MBBS, Timur Sarac, MD, Stephen Cha, MS, Manju Kalra, MBBS, Randall De Martino, MD, Thomas C. Bower, MD Journal of Vascular Surgery Volume 60, Issue 6, Pages 1612-1619.e2 (December 2014) DOI: 10.1016/j.jvs.2014.08.093 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 A, Occluded bifurcated mesenteric graft in a patient with acute mesenteric ischemia (AMI) was treated by emergency revision and thrombectomy. B, After exposure of the distal graft anastomosis, a longitudinal graftotomy was performed starting at the distal graft and extending to the native superior mesenteric artery (SMA). C, Catheter thrombectomy was used, (D) followed by revision of the distal anastomosis by patch angioplasty. E, Follow-up computed tomography angiography with patent graft limb. Reprinted by permission of Mayo Foundation for Medical Education and Research. All rights reserved. Journal of Vascular Surgery 2014 60, 1612-1619.e2DOI: (10.1016/j.jvs.2014.08.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 A, Computed tomography angiography of a patient with recurrent symptoms of chronic ischemia due to (B) occluded bifurcated supraceliac aorta-to-celiac and superior mesenteric artery (SMA) bypass graft. C, A redo bifurcated graft was performed from the supraceliac aorta. D, After exposure of the distal SMA limb anastomosis, a longitudinal graftotomy was made, followed by excision of the old graft and thrombectomy. Redo bypass was performed with (E) a distal anastomosis to the SMA and (F) a second limb to the hepatic artery. G, Repeat computed tomography angiography revealed a widely patent graft. Reprinted by permission of Mayo Foundation for Medical Education and Research. All rights reserved. Journal of Vascular Surgery 2014 60, 1612-1619.e2DOI: (10.1016/j.jvs.2014.08.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Selective angiography of the celiac limb of a stenosed aortomesenteric graft. The lesion was (B) crossed by wire and (C) treated by angioplasty and stenting using balloon-expandable stent. Journal of Vascular Surgery 2014 60, 1612-1619.e2DOI: (10.1016/j.jvs.2014.08.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 4 Kaplan-Meier survival estimates of freedom from (A) symptom recurrence and (B) reintervention in patients treated by redo open reconstruction (R-OR, blue line) or by endovascular revascularization (ER, red line). The dotted line indicates standard deviation >10%. Journal of Vascular Surgery 2014 60, 1612-1619.e2DOI: (10.1016/j.jvs.2014.08.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Supplementary Fig 1 (online only) Kaplan-Meier survival estimates of freedom from symptom recurrence in patients treated by redo open reconstruction (R-OR, blue line) or first-time OR (red line) for chronic mesenteric ischemia (CMI). The dotted line indicates standard deviation >10%. Journal of Vascular Surgery 2014 60, 1612-1619.e2DOI: (10.1016/j.jvs.2014.08.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Supplementary Fig 2 (online only) Kaplan-Meier survival estimates of freedom from reintervention in patients treated by redo open reconstruction (R-OR, blue line) or first-time OR (red line) for chronic mesenteric ischemia (CMI). The dotted line indicates standard deviation >10%. Journal of Vascular Surgery 2014 60, 1612-1619.e2DOI: (10.1016/j.jvs.2014.08.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Supplementary Fig 3 (online only) Kaplan-Meier survival estimates of primary patency in patients treated by redo open reconstruction (R-OR, blue line) or first-time OR (red line) for chronic mesenteric ischemia (CMI). The dotted line indicates standard deviation >10%. Journal of Vascular Surgery 2014 60, 1612-1619.e2DOI: (10.1016/j.jvs.2014.08.093) Copyright © 2014 Society for Vascular Surgery Terms and Conditions