© Springer Science+Business Media New York 2015
Gustavo S. Oderich (ed.)Mesenteric Vascular Disease10.1007/978-1-4939-1847-8_11. History of Mesenteric Vascular Disease
(1)
Division of Vascular and Endovascular Surgery, University of Virginia, Charlottesville, VA, USA
Although it is generally stated in any short historical introduction to an article concerning chronic mesenteric ischemia that Dunphy first correlated chronic abdominal pain to subsequent mesenteric artery occlusion and gut infarction in 1936, his paper did not arise suddenly from a barren field [1]. The problem with “mesenteric occlusion” and death from ischemic necrotic bowel had interested physicians for years previously. The problem was a complex one, but the impediments to understanding mesenteric ischemia and treating it were dishearteningly simple: neither diagnostic angiography nor vascular intervention was extant. Diagnosis was made during exploratory laparotomy for acute abdominal crises or at autopsy. Bowel resection was the sole surgical option.
Tiedemann had described mesenteric occlusion and bowel infarction in a patient in 1843 [2]. Seven years later, Virchow added two further such patients to the literature [3]. Welch, in 1887, had posited an 80 % stenosis of the SMA was necessary for ischemic bowel changes [4]. In 1904, Jackson, Parker, and Quinby described both arterial and venous occlusions of the mesenteric circulation [5]. Trotter, in 1913, reviewed 359 cases of infarcted bowel [5]. He proposed a relationship between heart disease and embolus to the superior mesenteric artery and a relationship between arteriosclerosis of the aorta and mesenteric vessels and local thrombosis of the visceral vessels. Klein pointed out in 1921 in his thesis on embolism and thrombosis of the superior mesenteric artery a relationship between superior mesenteric artery stenosis and episodic abdominal pain [6].
Cokkinis, a registrar at the London Lock Hospital, wrote a thesis in 1926, which is remarkable for several observations [7]. He reported 76 cases of “mesenteric occlusion” mostly from the London Hospital. He felt primary thrombosis of the mesenteric vessels rare, but reported one case with gangrene of the intestines and both lower extremities, and felt that atheromas of the aorta and mesenteric arteries themselves were causative, leading directly to thrombosis. He also described aortic-origin emboli.
Ten years before Dunphy’s postmortem study could confirm a history of postprandial pain and subsequent gut infarction, Cokkinis wrote: “The patient complains of abdominal symptoms extending over a period of weeks or months. Among the commonest of these are: colicky abdominal pain, which may have some relation to food…The symptoms are colicky abdominal pain, 1½ to 2 h after meals, nausea and vomiting…they may last for years and then arterial thrombosis supervenes and leads to infarction…The pathological lesion is one of arteriosclerosis of the mesenteric arteries, interfering with the flow of blood to the intestines during digestion.”
Given the lack of diagnostic modalities of the day, this is the most remarkable and accurate description of chronic mesenteric ischemia. All that is lacking for completeness sake is weight loss and fear of eating.
In 1936 in his famous report, Dunphy described 12 patients dying of mesenteric infarction studied at autopsy. Seven (58 %) had a history of recurrent abdominal pain proceeding the terminal event, a period of time ranging from weeks to years. The imperative for early treatment was thus identified, even if the means were not yet available.
Surgical Revascularization
In 1951, Klass performed direct embolectomy of the superior mesenteric artery in two patients [8]. One must remember at this point that the Fogarty catheter had not yet been invented. Both patients died, but the mesenteric circulation was free of thrombosis at the postmortem. Stewart, that same year, performed an SMA embolectomy [9]. Five years later Van Weel reported a successful thrombectomy, although the patient required subsequent resection of the distal ileum and cecum [10]. This would count as a success today. In 1957 Mikkelsen described the arteriographic findings of ostial mesenteric lesions [11].
The first embolectomy of the SMA to be successful and not to require subsequent bowel resection was performed in 1957 and reported by Shaw and Maynard [12]. Shaw with Rutledge in 1958 [13] reported endarterectomy of the SMA and paramesenteric aorta as treatment of chronic mesenteric ischemia. The remarkable Houston surgeons – Morris, Crawford, Cooley, and DeBakey – in 1962 reported retrograde reconstruction of the celiac and superior mesenteric arteries. It was associated with tortuosity and kinking of those grafts in some patients [14].
Wylie, Stoney, and Ehrenfield, in the 1970s, described both transaortic visceral endarterectomy and antegrade supraceliac bypass to the visceral vessels [15]. Initially, when performing endarterectomy, they employed a thoraco-retroperitoneal approach but modified this to medial visceral rotation in later years for appropriate patients.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
