To evaluate the feasibility and early outcomes of antegrade visceral revascularization using the supraceliac aorta as inflow in high-surgical-risk patients with chronic mesenteric ischemia (CMI) refractory to endovascular treatment.

A retrospective review was conducted from 2015 to 2022 including patients who underwent supraceliac to visceral bypass for symptomatic CMI after failed endovascular revascularization. All patients were deemed high risk based on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) score. Bypasses were performed through a transperitoneal midline approach using partial aortic cross-clamping. The primary outcome was 30-day mortality. Secondary outcomes included postoperative complications, intensive care unit (ICU) stay, and long-term survival.

Twelve patients (median age 75 years; 6 women) underwent surgery. Bypasses targeted the superior mesenteric artery alone ( n = 10) or combined with the common hepatic artery ( n = 2), using prosthetic ( n = 12) or venous grafts ( n = 2). Median aortic clamping time was 24 minutes. In this series there was no 30-day mortality. Postoperative complications were limited to one case of pneumonia and one transient acute kidney injury. Median ICU stay was 2 days. All patients experienced symptom resolution. At a median follow-up of 45 months, 11 of 12 patients were alive.

Antegrade revascularization from the supraceliac aorta via midline laparotomy is feasible in selected high-surgical-risk patients with CMI. This approach could be considered when endovascular options fail.