Endarterectomy of the thoracoabdominal aorta in acute and chronic intestinal ischemia

The atheromatous lesions underlying syndromes of coeliac-mesenteric ischemia sometimes not only affect the splanchnic arteries but can also involve the thoracoabdominal aorta. In these cases, aortic and transaortic endarterectomy (EA) of the visceral arteries represents an interesting alternative to bypass. In the literature, the long-term results are satisfactory, particularly in cases with associated renal EA. Moreover, there is a reduced incidence of ischemic recurrence probably due to the possibility, sustained by several authors, that this technique permits multi-truncular revascularisation. This paper reports a case of acute intestinal ischemia and one of chronic intestinal ischemia, conditioned by "suprarenal aortic Coral reef", which were successfully treated with transaortic EA of the visceral arteries with a follow-up of 6 months. The technical success of this surgical procedure in both patients was confirmed postoperatively by angiography in the first and by angioMR of the aorta and visceral arteries in the second. This experience confirms that transaortic EA in carefully selected patients can be a valid alternative to bypass in visceral revascularisation.