Chronic mesenteric ischaemia: 28-year experience of endovascular treatment
- 439 Downloads
To report the outcomes associated with endovascular therapy for patients with chronic mesenteric ischemia (CMI).
A retrospective review of patients who underwent endovascular therapy for CMI between April 1981 and September 2009 at a single institution was performed. Procedural details, mesenteric arteries treated, technical and clinical success rates, outcomes per patient and per vessel were assessed.
In 166 patients treatment was attempted using a variety of balloon and stent platforms during the 28-year period. The technical success rate was 97% per patient and 94% per vessel. The technical success rate of stenting (99.4%) was higher than for percutaneous transluminal angioplasty (PTA; 86%; P = 0.0001). Immediate clinical improvement was seen in 146 out of 166 (88.2%). The type of guidewire or device platform, brachial vs. femoral artery access, balloon and/or stent diameters used, and stenosis vs. occlusion had no statistical impact on mortality or the primary patency of any mesenteric artery outcomes. The outcome of the superior mesenteric artery (SMA) with PTA appears to be superior to that of stenting (P = 0.014).
Technical success rates are improved with the use of stents; however, PTA use in the SMA seems to offer better primary patency rates.
• Superior mesenteric artery (SMA) stenosis is often responsible for ischaemic symptoms.
• Treatment with percutaneous transluminal angioplasty (PTA) seems superior to stenting
• Although technical success rates are improved with the use of stents.
• Higher mortality in the elderly and those presenting with nausea/vomiting/bloody stools.
KeywordsMesenteric artery/blood supply Ischemia/etiology/therapy Angioplasty Balloon Stents Treatment outcome
Special thanks to Dorothy L. Cage RN, BSN for reviewing some of the patients’ data in this article.
Alan H. Matsumoto; Grant support: NIH, W.L. Gore, Medtronic, Cook, Insightec, Endologix. DSMB activities: Trivascular, Bolton Medical. Advisory Board/Consultant, Siemens Medical, St Judes Medical, Boston Scientific, Crux Medical, Bard Peripheral Vascular. Other authors; None.
Conflict of interest
We had no financial support or conflict of interest for this project.
- 25.Assar AN, Abilez OJ, Zarins CK (2009) Outcome of open versus endovascular revascularization for chronic mesenteric ischemia: review of comparative studies. J Cardiovasc Surg (Torino) 50(4):509–514Google Scholar