Thoracic aorta to inferior mesenteric artery bypass for treatment of chronic mesenteric ischemia

Despite the prevalence of mesenteric artery occlusive disease in the elderly population, revascularization for chronic mesenteric ischemia (CMI) accounts for <2 % of revascularization procedures. We describe a case of a 72-year-old male with CMI who previously underwent SMA angioplasty and stenting, and supraceliac aorta to superior mesenteric artery (SMA) bypass that subsequently thrombosed. We performed a right common iliac to SMA bypass with initial improvement in his symptoms. However, at one month follow-up, he had symptom recurrence with imaging revealing occlusion of his bypass. We subsequently performed a distal thoracic aorta to inferior mesenteric artery (IMA) bypass via a thoracoabdominal retroperitoneal approach, resulting in resolution of his symptoms.