Abstract
Aspects of bypass grafting for abdominal angina, including bypass graft used, bypass route, and selection of the bypassed artery, are controversial. We describe two cases of successful surgical revascularization for abdominal angina. In each case, antegrade bypass using a saphenous vein graft was performed with proximal anastomosis of the aorta cranial to the celiac artery. The first patient was a 61-year-old male complaining of both abdominal pain after meals and emaciation. His preoperative CT angiogram revealed obstructions of the celiac and superior mesenteric arteries. Bypass grafting using a composite saphenous vein graft was performed to the common hepatic artery and superior mesenteric artery. Parenteral hyper-alimentation was needed due to leakage of pancreatic juice for 3 months after surgery; thereafter, his recovery was good and his symptoms disappeared. Postoperative CT angiogram showed good patency of the composite vein graft. The second patient was a 65-year-old male complaining of intermittent abdominal pain and watery diarrhea. CT angiogram demonstrated obstructions of the celiac and superior mesenteric arteries and severe ostial stenosis of the inferior mesenteric artery complicated by an infra-renal aortic aneurysm. Saphenous vein bypass grafting was performed between the aorta and common hepatic artery as well as artificial graft replacement of the infrarenal aorta combined with revascularization of the inferior mesenteric artery. Postoperative angiogram showed a patent saphenous vein graft and good collateral flow from the inferior mesenteric artery to the superior mesenteric artery, and his symptoms had disappeared.
