Chronic mesenteric ischemia is an uncommon but potentially lethal clinical problem. At the present time, surgical revascularization remains the treatment of choice for most patients presenting with clinical symptoms and arteriographic evidence of chronic mesenteric ischemia. The appropriate management of patients with this complex problem demands competence with the entire spectrum of vascular reconstructive techniques, including bypass, <sup>1 Baur G.M., Millay D.J., Taylor L.M., Porter J.M. Treatment of chronic visceral ischemia Am J Surg 1984 ;  148 : 138-144  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 15 Johnston K.W., Lindsay T.F., Walker P.M., Kalman P.G. Mesenteric arterial bypass grafts: Early and late results and suggested surgical approach for chronic and acute mesenteric ischemia Surgery 1995 ;  118 : 1-7  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 19 McMillan W.D., McCarthy W.J., Bresticker M.R. , e al. Mesenteric artery bypass: Objective patency determination J Vasc Surg 1995 ;  21 : 729-740 ; discussion 740–741.  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 29 Zelenock G.B., Graham L.M., Whitehouse W.M. , e al. Splanchnic arteriosclerotic disease and intestinal angina Arch Surg 1980 ;  115 : 497-501

Cliccare qui per andare alla sezione Riferimenti</sup> endarterectomy, <sup>7 Cunningham C.G., Reilly L.M., Rapp J.H. , e al. Chronic visceral ischemia. Three decades of progress Ann Surg 1991 ;  214 : 276-287 ; discussion 287–288.  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 23 Rapp J.H., Reilly L.M., Qvarfordt P.G. , e al. Durability of endarterectomy and antegrade grafts in the treatment of chronic visceral ischemia J Vasc Surg 1986 ;  3 : 799-806  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> reimplantation, <sup>16 Kieny R., Batellier J., Kretz J.G. Aortic reimplantation of the superior mesenteric artery for atherosclerotic lesions of the visceral arteries: sixty cases Ann Vasc Surg 1990 ;  4 : 122-125  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> and angioplasty.<sup>17 Levy P.J., Haskell L., Gordon R.L. Percutaneous transluminal angioplasty of splanchnic arteries: An alternative method to elective revascularization in chronic visceral ischemia Eur J Radiol 1987 ;  7 : 239-242

Cliccare qui per andare alla sezione Riferimenti, 26 Rose S.C., Quigley T.M., Raker E.J. Revascularization for chronic mesenteric ischemia: Comparison of operative arterial bypass grafting and percutaneous transluminal angioplasty J Vasc Intervent Radiol 1995 ;  6 : 339-349  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The precise choice of operative procedure depends not only on the particular clinical circumstances but also on the judgment and experience of the operating surgeon. A critical review of the clinical literature suggests that no single technique is applicable to all patients and in all clinical circumstances. Despite strong institutional preferences and continuing controversy in the literature, no prospective, randomized clinical trials have clearly documented superiority of any single revascularization technique. Surgeons caring for patients with chronic mesenteric ischemia must have a thorough familiarity with the complex anatomy and surgical exposure of the paravisceral aorta to successfully treat these patients.

The purpose of this discussion is to briefly review the natural history, clinical presentation, and preoperative assessment of the patient with chronic mesenteric ischemia as they relate to the indications, techniques, and results of bypass grafting for this complex clinical problem. Other means of mesenteric revascularization are discussed elsewhere in this issue.