European Radiology

, Volume 22, Issue 6, pp 1372–1384 | Cite as

Chronic mesenteric ischaemia: 28-year experience of endovascular treatment

  • Ulku Cenk Turba
  • Wael E. Saad
  • Bulent Arslan
  • Saher S. Sabri
  • Stacey Trotter
  • John F. Angle
  • Klaus D. Hagspiel
  • John A. Kern
  • Kenneth J. Cherry
  • Alan H. Matsumoto



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.

Key Points

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.


Mesenteric 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.

Disclosure statement

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.


  1. 1.
    Schermerhorn ML, Giles KA, Hamdan AD, Wyers MC, Pomposelli FB (2009) Mesenteric revascularization: management and outcomes in the United States, 1988–2006. J Vasc Surg 50(2):341–348, e341PubMedCrossRefGoogle Scholar
  2. 2.
    Rutherford RB, Baker JD, Ernst C et al (1997) Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 26(3):517–538PubMedCrossRefGoogle Scholar
  3. 3.
    Matsumoto AH, Angle JF, Spinosa DJ et al (2002) Percutaneous transluminal angioplasty and stenting in the treatment of chronic mesenteric ischemia: results and longterm follow-up. J Am Coll Surg 194(1 Suppl):S22–S31PubMedCrossRefGoogle Scholar
  4. 4.
    Uflacker R, Goldany MA, Constant S (1980) Resolution of mesenteric angina with percutaneous transluminal angioplasty of a superior mesenteric artery stenosis using a balloon catheter. Gastrointest Radiol 5(4):367–369PubMedCrossRefGoogle Scholar
  5. 5.
    Furrer J, Gruntzig A, Kugelmeier J, Goebel N (1980) Treatment of abdominal angina with percutaneous dilatation of an arteria mesenterica superior stenosis. Preliminary communication. Cardiovasc Intervent Radiol 3(1):43–44PubMedCrossRefGoogle Scholar
  6. 6.
    Razavi M, Chung HH (2004) Endovascular management of chronic mesenteric ischemia. Tech Vasc Interv Radiol 7(3):155–159PubMedCrossRefGoogle Scholar
  7. 7.
    Landis MS, Rajan DK, Simons ME, Hayeems EB, Kachura JR, Sniderman KW (2005) Percutaneous management of chronic mesenteric ischemia: outcomes after intervention. J Vasc Interv Radiol 16(10):1319–1325PubMedCrossRefGoogle Scholar
  8. 8.
    Silva JA, White CJ, Collins TJ et al (2006) Endovascular therapy for chronic mesenteric ischemia. J Am Coll Cardiol 47(5):944–950PubMedCrossRefGoogle Scholar
  9. 9.
    Lee RW, Bakken AM, Palchik E, Saad WE, Davies MG (2008) Long-term outcomes of endoluminal therapy for chronic atherosclerotic occlusive mesenteric disease. Ann Vasc Surg 22(4):541–546PubMedCrossRefGoogle Scholar
  10. 10.
    Sarac TP, Altinel O, Kashyap V et al (2008) Endovascular treatment of stenotic and occluded visceral arteries for chronic mesenteric ischemia. J Vasc Surg 47(3):485–491PubMedCrossRefGoogle Scholar
  11. 11.
    Peck MA, Conrad MF, Kwolek CJ, LaMuraglia GM, Paruchuri V, Cambria RP (2010) Intermediate-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia. J Vasc Surg 51(1):140–147, e141-142PubMedCrossRefGoogle Scholar
  12. 12.
    Malgor RD, Oderich GS, McKusick MA et al (2010) Results of single- and two-vessel mesenteric artery stents for chronic mesenteric ischemia. Ann Vasc Surg 24(8):1094–1101PubMedCrossRefGoogle Scholar
  13. 13.
    Fioole B, van de Rest HJ, Meijer JR et al (2010) Percutaneous transluminal angioplasty and stenting as first-choice treatment in patients with chronic mesenteric ischemia. J Vasc Surg 51(2):386–391PubMedCrossRefGoogle Scholar
  14. 14.
    Kasirajan K, O'Hara PJ, Gray BH et al (2001) Chronic mesenteric ischemia: open surgery versus percutaneous angioplasty and stenting. J Vasc Surg 33(1):63–71PubMedCrossRefGoogle Scholar
  15. 15.
    Brown DJ, Schermerhorn ML, Powell RJ et al (2005) Mesenteric stenting for chronic mesenteric ischemia. J Vasc Surg 42(2):268–274PubMedCrossRefGoogle Scholar
  16. 16.
    Sivamurthy N, Rhodes JM, Lee D, Waldman DL, Green RM, Davies MG (2006) Endovascular versus open mesenteric revascularization: immediate benefits do not equate with short-term functional outcomes. J Am Coll Surg 202(6):859–867PubMedCrossRefGoogle Scholar
  17. 17.
    Biebl M, Oldenburg WA, Paz-Fumagalli R, McKinney JM, Hakaim AG (2007) Surgical and interventional visceral revascularization for the treatment of chronic mesenteric ischemia—when to prefer which? World J Surg 31(3):562–568PubMedCrossRefGoogle Scholar
  18. 18.
    Atkins MD, Kwolek CJ, LaMuraglia GM, Brewster DC, Chung TK, Cambria RP (2007) Surgical revascularization versus endovascular therapy for chronic mesenteric ischemia: a comparative experience. J Vasc Surg 45(6):1162–1171PubMedCrossRefGoogle Scholar
  19. 19.
    Zerbib P, Lebuffe G, Sergent-Baudson G et al (2008) Endovascular versus open revascularization for chronic mesenteric ischemia: a comparative study. Langenbeck Arch Surg 393(6):865–870CrossRefGoogle Scholar
  20. 20.
    Davies RS, Wall ML, Silverman SH et al (2009) Surgical versus endovascular reconstruction for chronic mesenteric ischemia: a contemporary UK series. Vasc Endovasc Surg 43(2):157–164CrossRefGoogle Scholar
  21. 21.
    Oderich GS, Bower TC, Sullivan TM, Bjarnason H, Cha S, Gloviczki P (2009) Open versus endovascular revascularization for chronic mesenteric ischemia: risk-stratified outcomes. J Vasc Surg 49(6):1472–1479, e1473PubMedCrossRefGoogle Scholar
  22. 22.
    Rawat N, Gibbons CP (2010) Surgical or endovascular treatment for chronic mesenteric ischemia: a multicenter study. Ann Vasc Surg 24(7):935–945PubMedCrossRefGoogle Scholar
  23. 23.
    Steinmetz E, Tatou E, Favier-Blavoux C et al (2002) Endovascular treatment as first choice in chronic intestinal ischemia. Ann Vasc Surg 16(6):693–699PubMedCrossRefGoogle Scholar
  24. 24.
    Oderich GS, Gloviczki P, Bower TC (2010) Open surgical treatment for chronic mesenteric ischemia in the endovascular era: when it is necessary and what is the preferred technique? Semin Vasc Surg 23(1):36–46PubMedCrossRefGoogle Scholar
  25. 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
  26. 26.
    Indes JE, Giacovelli JK, Muhs BE, Sosa JA, Dardik A (2009) Outcomes of endovascular and open treatment for chronic mesenteric ischemia. J Endovasc Ther 16(5):624–630PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Ulku Cenk Turba
    • 1
    • 4
  • Wael E. Saad
    • 1
  • Bulent Arslan
    • 2
  • Saher S. Sabri
    • 1
  • Stacey Trotter
    • 3
  • John F. Angle
    • 1
  • Klaus D. Hagspiel
    • 1
  • John A. Kern
    • 1
  • Kenneth J. Cherry
    • 1
  • Alan H. Matsumoto
    • 1
  1. 1.Interventional RadiologyUniversity of VirginiaCharlottesvilleUSA
  2. 2.Interventional RadiologyH. Lee Moffitt Cancer Center & Research InstituteTampaUSA
  3. 3.Johns Hopkins, RadiologyBaltimoreUSA
  4. 4.University of Virginia Health SystemCharlottesvilleUSA

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