Endovascular treatment of chronic mesenteric ischemia: report of five cases.
OBJECTIVE
To evaluate the midterm results of percutaneous transluminal angioplasty (PTA) and stent placement in stenotic and occluded mesentesic arteries in five consecutive patients with chronic mesenteric ischemia.


METHODS
Five patients with 70%-100% obliterations of all mesenteric vessels resulting in chronic mesenteric ischemia (n = 4) and as a prophylactic measure prior to abdominal aortic aneurysm repair (n = 1) underwent PTA of celiac and/or superior mesenteric artery (SMA) stenoses (n = 2), primary stenting of ostial celiac occlusions (n = 2), and secondary stenting of a SMA occlusion (n = 1; recoil after initial PTA). All patients underwent duplex ultrasonography (US) (n = 3) and/or angiography (n = 5) during a median follow-up of 21 months (range 8-42 months).


RESULTS
Clinical success was obtained in all five patients. Asymptomatic significant late restenoses (n = 3) were successfully treated with repeat PTA (n = 2) and stenting of an SMA occlusion (n = 1; celiac stent restenosis). Recurrent pain in one patient was interpreted as secondary to postsurgical abdominal adhesions. Two puncture-site complications occurred requiring local surgical treatment.


CONCLUSIONS
Endovascular techniques may be attempted prior to surgery in cases of stenotic or short occlusive lesions in patients with chronic mesenteric ischemia. Surgery may still be preferred in patients with long occlusions and a low operative risk.
Section of Vascular and Interventional Radiology, Department of Diagnostic Radiology, Malmö University Hospital, University of Lund, S-205 02 Malmö, Sweden.
U
U
Nyman
K
K
Ivancev
M
M
Lindh
P
P
Uher
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation* / Q000379:methods; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000628:therapy*; D008297:Male; D008638:Mesenteric Arteries; D008641:Mesenteric Vascular Occlusion / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008643:Mesentery / Q000098:blood supply*; D008875:Middle Aged; D015607:Stents