[Diagnosis and surgical treatment of abdominal angina caused by atheromatous stenosis of the digestive arteries].
The diagnosis and technical aspects of revascularization are discussed in a series of 14 consecutive cases of intestinal arterial insufficiency. The typical clinical presentation of post-prandial pain and weight loss was found in 12 out of 14 cases. Gastroenterological investigations demonstrated associated lesions in 8 cases, including 5 cases of gastroduodenal ulcer disease where this was initially considered responsible for the symptomatology. No case of malabsorption was noted. Angiography demonstrated involvement of the three splanchnic vessels in 7 cases, two vessels in 6 cases and one vessel only in the remaining case. The revascularization techniques were as follows: reimplantation of the superior mesenteric (n = 1), bypass from the sub-renal aorta (n = 5), or a sub-renal aortic graft (n = 2) or supra-coeliac aorta (n = 6). Control angiography demonstrated permeability in 9 out of 10 cases where this examination was carried out. The early results included one post operative mortality. From a nutritional and functional point of view they were three failures and ten good results. Overall, follow up and survival ranged from 6 months to 9 years. In five cases death was due to secondary causes. Abdominal angina occurs in a population at high vascular risk. In view of this etiology the diagnosis should be considered at an early stage and this also explains the secondary mortality. Gastroduodenal ulcerative lesions may occur as part of the clinical presentation. The angiographic data confirmed the Mikkelsen rule, however the functional effects of stenosis could be better evaluated by pulsed echo-doppler.(ABSTRACT TRUNCATED AT 250 WORDS)