الفهرس 
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Abstract
Background: Chronic mesenteric ischemia (CMI) is an area of diagnostic and surgical challenge. Surgical management remains the standard line of treatment. The ideal bypass technique and conduit type carry a lot of debate. Using autogenous vein as a conduit in such cases carries the drawback of kinking and hence, threatening graft patency. Aim of study: The study evaluated surgical revascularization of CMI done by retrograde aortomesenteric bypass using a conduit of autogenous saphenous vein graft. Multislice CT angiography (MSCTA) was the radiological modality of choice in preoperative diagnosis and postoperative technique evaluation. Patients and methods: In a retrospective study, ten patients presenting with CMI mainly due to atherosclerotic steno-occlusive disease of both celiac and superior mesenteric arteries (CA & SMA) are included (3 females and 7 males with age range from 42 to 67 years). Associated vascular diseases were infrarenal abdominal aortic aneurysm (AAA) in one case and previous vascular intervention as occluded celiac stents in 2 cases and aortobi-iliac bypass graft in one case. Diagnosis was confirmed by MSCTA. All patients were prepared for retrograde aortomesenteric bypass using saphenous vein graft. The graft passes in front of the left renal pedicle high up to come in an antegrade fashion to the SMA; (a simplified French technique) where the graft passes in front instead of behind the left renal pedicle. As the graft course passes in different planes and directions, MSCTA was routinely done postoperatively to evaluate the technique, graft patency, and possible postoperative vascular complications. Results: All patients were successfully recovered from symptoms after the procedure with
disappearance of postprandial pain and food fear. Postoperative MSCTA revealed patent grafts with smooth course and filling of the distal branches of SMA. No kinks were found in any of the grafts. There was no mortality and all patients were discharged within two weeks. One postoperative complication was graft limb occlusion in patient with previous aortobi-iliac bypass in whom, femorofemoral crossover bypass was done for revascularization and restoration of the pedal pulses. Conclusion: The simplified French technique is feasible and avoids retroperitoneal dissection, hematoma formation or septic complications. Graft loop can be seen during the procedure without kinking. Looping and anchoring at the ligament of Treitz allows preservation of the loop, obtaining access to SMA from above downwards for distal anastomosis taking the combined benefit of antegrade and retrograde bypasse.