Tratamiento quirúrgico de la isquemia mesentérica crónica, revisión de la literatura y presentación de un caso
Palabras clave:
oclusión vascular mesentérica, procedimientos quirúrgicos vasculares, procedimientos endovasculares, prótesis vascularResumen
Los problemas vasculares mesentéricos son infrecuentes pero, cuando se presentan, pueden ser catastróficos. La isquemia mesentérica crónica es una entidad caracterizada por la obstrucción de los vasos mesentéricos; se manifiesta por dolor abdominal después de las comidas, desnutrición y miedo a comer. La mortalidad de la isquemia aguda es de 50 a 70 %.
El manejo quirúrgico es la terapia de elección con excelentes resultados. El objetivo del tratamiento de la isquemia mesentérica crónica es solucionar los síntomas con un procedimiento efectivo y duradero, disminuyendo el riesgo de isquemia aguda.
El tratamiento óptimo aun es discutido aunque la cirugía abierta se considera el método de referencia del manejo; no obstante, se asocia a una morbimortalidad importante.
Presentamos el caso de un paciente con una isquemia mesentérica crónica, que se manejó con cirugía abierta y excelente resultado clínico y nutricional. Se hace una revisión extensa de la literatura científica actual.
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Referencias bibliográficas
1. Ryer EJ, Oderich GS, Bower TC, Macedo TA, Vrtiska TJ, Dun- can AA, et al. Differences in anatomy and outcomes in patients treated with open mesenteric revascularization before and after the endovascular era. J Vasc Surg. 2011;53:1611-8.
https://doi.org/10.1016/j.jvs.2011.01.054
2. Harvey CF, Barros AA. Reconstructive vascular surgery for intestinal angina. Ann Surg. 1975;182:430.
3. Farber MA, Carlin RE, Marston WA, Owens LV, Burnham SJ, Keagy BA. Distal thoracic aorta as inflow for the treatment of chronic mesenteric ischemia. J Vasc Surg. 2001;33:281-8.
https://doi.org/10.1067/mva.2001.111810
4. Valentine J. Vascular exposures of visceral arteries. In: Valentine RJ, Wind GG. Anatomic exposures in vascular surgery. Philadel- phia: Lippincott, Williams & Wilkins;2002. p. 203-18.
5. Foley MI, Moneta GL, Abou-Zamzam Jr, Edwards JM, Taylor LM Jr, Yeager RA, et al. Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia. J Vasc Surg. 2000;32:37-47.
https://doi.org/10.1067/mva.2000.107314
6. Marín J, Manríquez L, Schweizer H, Téllez J, Rossel G. Trata- miento quirúrgico de la isquemia mesentérica crónica: caso clínico. Rev Méd Chile. 2007;135:92-7.
https://doi.org/10.4067/S0034-98872007000100013
7. Rogers DM, Thompson JE, Garrett WV, Talkington CM, Patman RD. Mesenteric vascular problems: A 26-year experience. Ann Surg. 1982;195:45-9.
https://doi.org/10.1097/00000658-198205000-00004
8. Stoney RJ, Ehrenfeld WK, Wylie EJ. Revascularization methods in chronic visceral ischemia caused by atherosclerosis. Ann Surg. 1977;186:123-7.
https://doi.org/10.1097/00000658-197710000-00008
9. Park WM, Cherry KJ Jr, Chua HK, Clark RC, Jenkins G, Harmsen WS, et al. Current results of open revascularization for chronic mesenteric ischemia: A standard for comparison. J Vasc Surg. 2002;35:853-9.
https://doi.org/10.1067/mva.2002.123753
10. Eklof B, Hoevels J, Ihse I. The surgical treatment of chronic intestinal ischemia. Ann Surg. 1978;187:65-71.
https://doi.org/10.1097/00000658-197803000-00019
11. Mell MW, Acher CW, Hoch JR, Tefera G, Turnipseed WD. Outcomes after endarterectomy for chronic mesenteric ischemia. J Vasc Surg. 2008;48:1132-8.
https://doi.org/10.1016/j.jvs.2008.06.033
12. Brown DJ, Schermerhorn ML, Powell RJ, Fillinger MF, Rzu- cidlo EM, Walsh DB, et al. Mesenteric stenting for chronic mesenteric ischemia. J Vasc Surg. 2005;42:268-74.
https://doi.org/10.1016/j.jvs.2005.03.054
13. Cho J-S, Carr JA, Jacobsen G, Shepard AD, Nypaver TJ, Reddy DJ. Long-term outcome after mesenteric artery reconstruction: A 37-year experience. J Vasc Surg. 2002;35:453-60.
https://doi.org/10.1067/mva.2002.118593
14. Modrall JG, Sadjadi J, Joiner DR, Ali A, Welborn MB III, Jackson MR, et al. Comparison of superficial femoral vein and saphenous vein as conduits for mesenteric arterial bypass. J Vasc Surg. 2003;37:362-6.
https://doi.org/10.1067/mva.2003.21
15. Sarac TP, Altinel O, Kashyap V, Bena J, Lyden S, Sruvastava S, et al. Endovascular treatment of stenotic and occluded vis- ceral arteries for chronic mesenteric ischemia. J Vasc Surg. 2008;47:485-91.
https://doi.org/10.1016/j.jvs.2007.11.046
16. Kasirajan K, O'Hara PJ, Gray B, Hertzer NR, Clair DG, Green- berg RK, et al. Chronic mesenteric ischemia: Open surgery versus percutaneous angioplasty and stenting. J Vasc Surg. 2001;33:63-71.
https://doi.org/10.1067/mva.2001.111808
17. Kougias P, Huynh TT, Lin PH. Clinical outcomes of mesenteric artery stenting versus surgical revascularization in chronic mes- enteric ischemia. Int Angiol. 2009;28:132-7.
18. Peck MA, Conrad MF, Kwolek CJ, LaMuraglia GM, Paruchuri V, Cambria RP. Intermediate-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia. J Vasc Surg. 2010;5:140-7
https://doi.org/10.1016/j.jvs.2009.06.064
19. Wyers MC, Powell RJ, Nolan BW, Cronenwett JL. Retrograde mesenteric stenting during laparotomy for acute occlusive mes- enteric ischemia. J Vasc Surg. 2007;45:269-75.
https://doi.org/10.1016/j.jvs.2006.10.047
20. Milner R, Woo EY, Carpenter JP. Superior mesenteric artery angioplasty and stenting via a retrograde approach in a patient with bowel ischemia-a case report. Vasc Endovascular Surg. 2004;38:89-91.
https://doi.org/10.1177/153857440403800112
21. Biebl M, Oldenburg WA, Paz-Fumagalli R, McKinney JM, Hakaim AG. Endovascular treatment as a bridge to successful surgical revascularization for chronic mesenteric ischemia. Am Surg. 2004;70:994-8.
22. Resch T, Lindh M, Dias N, Sonesson B, Uher P, Malina M, Ivancev K. Endovascular recanalisation in occlusive mesenteric ischemia -Feasibility and early results. Eur J Vasc Endovasc Surg. 2005;29:90-6
https://doi.org/10.1016/j.ejvs.2004.11.004
23. Atkins MD, Kwolek CJ, LaMuraglia GM, Brewster DC, Chung TK, Cambria RP. Surgical revascularization versus endovascular therapy for chronic mesenteric ischemia: A comparative experi- ence. J Vasc Surg. 2007;45:1162-71.
https://doi.org/10.1016/j.jvs.2007.01.067
24. Allen R, Gordon M, Chet R, Rivera F, Talkington C, Garret W, et al. Mesenteric angioplasty in the treatment of chronic mesenteric ischemia, J Vasc Surg. 1996;24:415-23.
https://doi.org/10.1016/S0741-5214(96)70197-0
25. Sog Y, Yokoi H, Iwabuchi M, Nobuyoshi M. Endovascular treat- ment of chronic mesenteric ischemia. Circ J. 2008;72:1198-200.
https://doi.org/10.1253/circj.72.1198
26. Moyes LH, McCarter DHA, Vass DG, Orr DJ. Intraoperative retrograde mesenteric angioplasty for acute occlusive mes- enteric ischaemia: A case series. Eur J Vasc Endovasc Surg. 2008;36:203e-6e.
https://doi.org/10.1016/j.ejvs.2008.01.019
27. Sharafuddin MJ, Olson CH, Sun S, Kresowik TF, Corson JD. Endovascular treatment of celiac and mesenteric arteries stenoses: Applications and results. J Vasc Surg. 2003;38:692-8.
https://doi.org/10.1016/S0741-5214(03)01030-9
28. Kruger AJ, Walker PJ, Foster WJ, Jenkins JS, Boyne NS, Jenkins J. Open surgery for atherosclerotic chronic mesenteric ischemia. J Vasc Surg. 2007;46:941-5.
https://doi.org/10.1016/j.jvs.2007.06.036
29. Roobottom CA, McCormick H, Resnick M, Fisher U, Dasgupta Y, López MJ. Mesenteric artherosclerosis and peripheral vascu- lar disease. American J Roentgenol. 1993;161:985-8.
https://doi.org/10.2214/ajr.161.5.8273642
30. Bradburry K, Leers P, Peterson J, Savisky L, Lee T, Porter K. Peripheral vascular disease and mesenteric occlusions. Br J Surg. 1995;82:1446-59.
https://doi.org/10.1002/bjs.1800821223
https://doi.org/10.1016/j.jvs.2011.01.054
2. Harvey CF, Barros AA. Reconstructive vascular surgery for intestinal angina. Ann Surg. 1975;182:430.
3. Farber MA, Carlin RE, Marston WA, Owens LV, Burnham SJ, Keagy BA. Distal thoracic aorta as inflow for the treatment of chronic mesenteric ischemia. J Vasc Surg. 2001;33:281-8.
https://doi.org/10.1067/mva.2001.111810
4. Valentine J. Vascular exposures of visceral arteries. In: Valentine RJ, Wind GG. Anatomic exposures in vascular surgery. Philadel- phia: Lippincott, Williams & Wilkins;2002. p. 203-18.
5. Foley MI, Moneta GL, Abou-Zamzam Jr, Edwards JM, Taylor LM Jr, Yeager RA, et al. Revascularization of the superior mesenteric artery alone for treatment of intestinal ischemia. J Vasc Surg. 2000;32:37-47.
https://doi.org/10.1067/mva.2000.107314
6. Marín J, Manríquez L, Schweizer H, Téllez J, Rossel G. Trata- miento quirúrgico de la isquemia mesentérica crónica: caso clínico. Rev Méd Chile. 2007;135:92-7.
https://doi.org/10.4067/S0034-98872007000100013
7. Rogers DM, Thompson JE, Garrett WV, Talkington CM, Patman RD. Mesenteric vascular problems: A 26-year experience. Ann Surg. 1982;195:45-9.
https://doi.org/10.1097/00000658-198205000-00004
8. Stoney RJ, Ehrenfeld WK, Wylie EJ. Revascularization methods in chronic visceral ischemia caused by atherosclerosis. Ann Surg. 1977;186:123-7.
https://doi.org/10.1097/00000658-197710000-00008
9. Park WM, Cherry KJ Jr, Chua HK, Clark RC, Jenkins G, Harmsen WS, et al. Current results of open revascularization for chronic mesenteric ischemia: A standard for comparison. J Vasc Surg. 2002;35:853-9.
https://doi.org/10.1067/mva.2002.123753
10. Eklof B, Hoevels J, Ihse I. The surgical treatment of chronic intestinal ischemia. Ann Surg. 1978;187:65-71.
https://doi.org/10.1097/00000658-197803000-00019
11. Mell MW, Acher CW, Hoch JR, Tefera G, Turnipseed WD. Outcomes after endarterectomy for chronic mesenteric ischemia. J Vasc Surg. 2008;48:1132-8.
https://doi.org/10.1016/j.jvs.2008.06.033
12. Brown DJ, Schermerhorn ML, Powell RJ, Fillinger MF, Rzu- cidlo EM, Walsh DB, et al. Mesenteric stenting for chronic mesenteric ischemia. J Vasc Surg. 2005;42:268-74.
https://doi.org/10.1016/j.jvs.2005.03.054
13. Cho J-S, Carr JA, Jacobsen G, Shepard AD, Nypaver TJ, Reddy DJ. Long-term outcome after mesenteric artery reconstruction: A 37-year experience. J Vasc Surg. 2002;35:453-60.
https://doi.org/10.1067/mva.2002.118593
14. Modrall JG, Sadjadi J, Joiner DR, Ali A, Welborn MB III, Jackson MR, et al. Comparison of superficial femoral vein and saphenous vein as conduits for mesenteric arterial bypass. J Vasc Surg. 2003;37:362-6.
https://doi.org/10.1067/mva.2003.21
15. Sarac TP, Altinel O, Kashyap V, Bena J, Lyden S, Sruvastava S, et al. Endovascular treatment of stenotic and occluded vis- ceral arteries for chronic mesenteric ischemia. J Vasc Surg. 2008;47:485-91.
https://doi.org/10.1016/j.jvs.2007.11.046
16. Kasirajan K, O'Hara PJ, Gray B, Hertzer NR, Clair DG, Green- berg RK, et al. Chronic mesenteric ischemia: Open surgery versus percutaneous angioplasty and stenting. J Vasc Surg. 2001;33:63-71.
https://doi.org/10.1067/mva.2001.111808
17. Kougias P, Huynh TT, Lin PH. Clinical outcomes of mesenteric artery stenting versus surgical revascularization in chronic mes- enteric ischemia. Int Angiol. 2009;28:132-7.
18. Peck MA, Conrad MF, Kwolek CJ, LaMuraglia GM, Paruchuri V, Cambria RP. Intermediate-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia. J Vasc Surg. 2010;5:140-7
https://doi.org/10.1016/j.jvs.2009.06.064
19. Wyers MC, Powell RJ, Nolan BW, Cronenwett JL. Retrograde mesenteric stenting during laparotomy for acute occlusive mes- enteric ischemia. J Vasc Surg. 2007;45:269-75.
https://doi.org/10.1016/j.jvs.2006.10.047
20. Milner R, Woo EY, Carpenter JP. Superior mesenteric artery angioplasty and stenting via a retrograde approach in a patient with bowel ischemia-a case report. Vasc Endovascular Surg. 2004;38:89-91.
https://doi.org/10.1177/153857440403800112
21. Biebl M, Oldenburg WA, Paz-Fumagalli R, McKinney JM, Hakaim AG. Endovascular treatment as a bridge to successful surgical revascularization for chronic mesenteric ischemia. Am Surg. 2004;70:994-8.
22. Resch T, Lindh M, Dias N, Sonesson B, Uher P, Malina M, Ivancev K. Endovascular recanalisation in occlusive mesenteric ischemia -Feasibility and early results. Eur J Vasc Endovasc Surg. 2005;29:90-6
https://doi.org/10.1016/j.ejvs.2004.11.004
23. Atkins MD, Kwolek CJ, LaMuraglia GM, Brewster DC, Chung TK, Cambria RP. Surgical revascularization versus endovascular therapy for chronic mesenteric ischemia: A comparative experi- ence. J Vasc Surg. 2007;45:1162-71.
https://doi.org/10.1016/j.jvs.2007.01.067
24. Allen R, Gordon M, Chet R, Rivera F, Talkington C, Garret W, et al. Mesenteric angioplasty in the treatment of chronic mesenteric ischemia, J Vasc Surg. 1996;24:415-23.
https://doi.org/10.1016/S0741-5214(96)70197-0
25. Sog Y, Yokoi H, Iwabuchi M, Nobuyoshi M. Endovascular treat- ment of chronic mesenteric ischemia. Circ J. 2008;72:1198-200.
https://doi.org/10.1253/circj.72.1198
26. Moyes LH, McCarter DHA, Vass DG, Orr DJ. Intraoperative retrograde mesenteric angioplasty for acute occlusive mes- enteric ischaemia: A case series. Eur J Vasc Endovasc Surg. 2008;36:203e-6e.
https://doi.org/10.1016/j.ejvs.2008.01.019
27. Sharafuddin MJ, Olson CH, Sun S, Kresowik TF, Corson JD. Endovascular treatment of celiac and mesenteric arteries stenoses: Applications and results. J Vasc Surg. 2003;38:692-8.
https://doi.org/10.1016/S0741-5214(03)01030-9
28. Kruger AJ, Walker PJ, Foster WJ, Jenkins JS, Boyne NS, Jenkins J. Open surgery for atherosclerotic chronic mesenteric ischemia. J Vasc Surg. 2007;46:941-5.
https://doi.org/10.1016/j.jvs.2007.06.036
29. Roobottom CA, McCormick H, Resnick M, Fisher U, Dasgupta Y, López MJ. Mesenteric artherosclerosis and peripheral vascu- lar disease. American J Roentgenol. 1993;161:985-8.
https://doi.org/10.2214/ajr.161.5.8273642
30. Bradburry K, Leers P, Peterson J, Savisky L, Lee T, Porter K. Peripheral vascular disease and mesenteric occlusions. Br J Surg. 1995;82:1446-59.
https://doi.org/10.1002/bjs.1800821223
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Publicado
2012-01-01
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Jiménez, C. E.; Valencia, Álex; Correa, J. R. Tratamiento quirúrgico De La Isquemia mesentérica crónica, revisión De La Literatura Y presentación De Un Caso. Rev Colomb Cir 2012, 27, 55-62.
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