A new method to revascularize the celiac axis.

Abstract

While the fact that chronic celiac artery obstruction is compatible with long-term survival has been known to the patholgist for more than a century,3 the clinical significance of this condition as a possible cause of upper abdominal discomfort and pain has been appreciated only for the past three decades. 1, 2, 4-26 Three different factors have been incriminated as the principal cause of this disease: arteriosclerosis 6, 8, 1g°’s fibroelaStoSiS2’ and compression by the arcuate ligament. 1, 7, 9, 17, 24, 26 Operative indication for celiac artery disease is a controversial issue. While most investigators’, 6, 9, 12, 14, 16 believe that isolated celiac artery obstruction could indeed cause significant clinical symptoms, others 13, &dquo;° 18, 24 state that blood flow through the mesenteric artery usually compensates for celiac artery disease, and the syndrome of &dquo;abdominal angina&dquo; does not occur unless both of these vessels are diseased. Szilagyi, 25 a noted authority in the field, even doubts the existence of celiac artery obstruction as a clinical syndrome. In cases where the impediment of the celiac flow is caused by external compression by the arcuate ligament, simple division of this ligament proved to be an effective solution.!’ 9, 16, z4° ~’b If the cause of the obstruction, however, lies in the arterial wall or within the lumen, it is evident that a more radical procedure is necessary. Studying the pathologic anatomy of celiac artery disease in 1961, Morris&dquo; found that a direct attack on this short and hidden artery had a number of undesirable technical features, and recommended the &dquo;adaption of the bypass principle as the safest and most satisfactory method&dquo; for restoring normal circulation in the splanchnic area. To him the splenic artery appeared to be the most suitable vessel to receive a bypass graft intended to revascularize the entire celiac system. Morrisl8° 19 indeed performed a number of successful such operations using knitted Dacron tubes anastomosed end-to-side to the abdominal aorta and the