title: Mesenteric angioplasty in the treatment of chronic intestinal ischemia.
abstract: OBJECTIVE
  This study was undertaken to determine the safety and efficacy of percutaneous transluminal angioplasty (PTA) in the treatment of chronic mesenteric ischemia (CMI) in very high-risk surgical patients.
  
  
  METHODS
  Twenty-four focal mesenteric stenoses treated from 1984 to 1994 by PTA in 19 patients with CMI were reviewed. All 19 patients were considered poor surgical candidates. Seventeen patients had classic symptoms of CMI, and two patients had atypical abdominal complaints. Vessels dilated included the superior mesenteric artery (18), celiac artery (3), inferior mesenteric artery (1), aorta-superior mesenteric artery vein graft (1), and aorta-splenic artery vein graft (1). Complete follow-up was possible in all patients, with the exception of one patient who had no symptoms when last seen 17 months after the procedure.
  
  
  RESULTS
  PTA was technically successful in 18 of 19 patients (95%) and 23 of 24 stenoses (96%). The lone technical failure resulted in superior mesenteric artery dissection with thrombosis and bowel infarction; the patient died despite emergent laparotomy and revascularization (mortality rate, 5%). Complete symptomatic relief was attained in 15 patients (79%), with follow-up showing continued relief of symptoms for a mean of 39 months (range, 4 to 101 months). Partial symptomatic relief was attained in three patients. Recurrent symptoms developed in three patients (20%) at a mean interval of 28 months (range, 9 to 43 months). Repeat PTA performed in two patients provided good technical results and relief from clinical symptoms. One patient had a symptomatic axillary sheath hematoma that required surgical decompression.
  
  
  CONCLUSIONS
  Mesenteric PTA is a valuable treatment option in patients who have CMI and are considered very high operative risks. The initial technical success rate is excellent, with the majority of patients having complete symptomatic improvement and continued relief of symptoms at short-term follow-up.
authors.affiliation: Department of General Surgery, Baylor University Medical Center, TX, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Allen
authors.forename: G H
authors.initials: GH
authors.lastname: Martin
authors.forename: C R
authors.initials: CR
authors.lastname: Rees
authors.forename: F J
authors.initials: FJ
authors.lastname: Rivera
authors.forename: C M
authors.initials: CM
authors.lastname: Talkington
authors.forename: W V
authors.initials: WV
authors.lastname: Garrett
authors.forename: B L
authors.initials: BL
authors.lastname: Smith
authors.forename: G J
authors.initials: GJ
authors.lastname: Pearl
authors.forename: N G
authors.initials: NG
authors.lastname: Diamond
authors.forename: S P
authors.initials: SP
authors.lastname: Lee
authors.forename: J E
authors.initials: JE
authors.lastname: Thompson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome