Hybrid approach to chronic and acute-on-chronic mesenteric ischemia with retrograde stenting of the superior mesenteric artery via jejunal arterial access

Since its introduction, endovascular stenting of the superior mesenteric artery (SMA) has been utilized as a technically feasible, safe, and efficient alternative to open surgery for patients with acute, chronic, and acute-on-chronic mesenteric ischemia resulting in significant reduction in both complication rates and perioperative mortality. Retrograde mesenteric stenting has been previously described; however, the need for formal laparotomy and arteriotomy represents a significant limitation of this approach, especially in elderly and malnourished patients. To this end, at our institution we developed and evaluated a novel hybrid approach to retrograde SMA revascularization via jejunal arterial access that requires a mini-laparotomy. Our initial experience shows that by mitigating the necessity for mesenteric dissection and formal laparotomy it is feasible to minimize the risks of extensive intra-abdominal surgery to this population.

Duke Scholars

Author Cynthia Keene Shortell Surgery, Vascular and Endovascular Surgery