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Ilio-mesenteric bypass for chronic mesenteric ischaemia where prior endovascular treatment has failed: a case series

Background: Symptomatic chronic mesenteric ischaemia is a rare but debilitating disease, and its diagnosis is often delayed by the time taken to rule out underlying malignancy or other abdominal pathology. Once diagnosed, definitive revascularisation should not be delayed to avoid future bowel infarction. There is no consensus on the best treatment option, but most centres use angioplasty as the first choice, leaving open surgery for those who are unsuitable for or failed endovascular treatment. Failure of endovascular treatment does not seem to preclude open surgical bypass. Methods: This series includes four patients who presented with symptomatic chronic mesenteric ischaemia in whom endovascular treatment failed and who were then managed successfully with ilio-mesenteric bypass, with average follow-up of 4 years. Results: The average age of the patients was 57 years; three of the four patients were female. Two patients had initial successful angioplasty but required bypass later for recurrent symptoms. In the other two cases the endovascular approach failed immediately, with one developing acute ischaemia requiring bowel resection followed by mesenteric bypass. Conclusion: Mesenteric bypass for symptomatic chronic mesenteric ischaemia is feasible after failed angioplasty. Immediate or delayed failure of endovascular treatment does not seem to preclude future surgery.