Sequential Single-Conduit Antegrade Flow Reconstruction for Multivessel Chronic Mesenteric Ischemia After Failed Endovascular Therapy

Chronic mesenteric ischemia (CMI) with multivessel occlusive disease remains challenging when endovascular therapy fails. We describe sequential antegrade reconstruction of the superior mesenteric artery (SMA) and celiac artery using a single 8-mm Dacron conduit originating from the supraceliac aorta. A 59-year-old man with severe malnutrition presented with progressive postprandial abdominal pain and substantial weight loss. Computed tomography angiography revealed flush occlusion of the celiac trunk, heavily calcified chronic total occlusion of the proximal SMA, patent distal target vessels, and limited collateralization through a diminutive inferior mesenteric artery. After two unsuccessful endovascular attempts, open revascularization was performed. The distal SMA was selected beyond the occluded segment, and the celiac trunk was reimplanted onto the same graft to preserve antegrade physiologic inflow while avoiding additional conduits. The patient recovered uneventfully and remained asymptomatic with patent graft at 3 months. This report outlines considerations for conduit configuration in CMI after failed endovascular therapy.