Mesenteric revascularization during aneurysmectomy.

Abstract

The most important association between aortic aneurysm surgery and the mesenteric circulation is the potential for inadvertent compromise to the mesenteric trunks and their end organs. Preservation of visceral blood flow is a critical objective in each case, using methods that have been developed as techniques for suprarenal abdominal and thoracoabdominal aneurysmectomy have evolved. Beyond simply preserving what existed, revascularization by endarterectomy or bypass has a role in selected cases to improve the natural history of advanced mesenteric occlusive disease, although the rationale for such prophylactic surgery must remain relatively weak until more is learned about disease progression in the visceral arteries. Finally, a small number of patients with mesenteric ischemic symptoms at the time of aneurysmectomy clearly benefit from combined surgery.