Endovascular therapy for chronic mesenteric ischemia.
OBJECTIVE
The purpose of this article is to report on the effectiveness and durability of endovascular therapy for obstructive disease of the superior mesenteric artery and celiac trunk.


METHODS
Our retrospective study population included nine patients (five women, four men; mean age 64 years, range 34-83 years) with 15 lesions. The indication for endovascular therapy was chronic mesenteric ischemia. The technical and clinical success rates and the incidence of complications were determined. Follow-up parameters included maintained patency and sustained clinical benefit.


RESULTS
Ten vessels were treated. The primary technical and clinical success rates were both 100% with no perioperative mortality. Major complications occurred in two patients (pseudoaneurysms). During a mean follow-up of 31 +/- 18 months (range 3-60 months), thrombosis occurred in two patients at 1 and 3 months after the procedures, respectively. Thrombosis was successfully treated by catheter-directed intraarterial thrombolysis followed by percutaneous transluminal angioplasty (PTA) (n = 1) or stenting (n = 1). At 2 and 5 years, the primary patency rate was 78%, whereas survival was estimated to be 85% and 68% at 2 and 5 years, respectively. At this follow-up, all patients had obtained relief of symptoms.


CONCLUSIONS
Our experience suggests that endovascular treatment for chronic mesenteric arterial obstructive disease is feasible, with a low incidence of complications and acceptable midterm results.
Piffaretti
Gabriele
G
Division of Vascular Surgery, Department of Surgery, University of Insubria, Ospedale di Circolo, Viale Borri 57, 21100, Varese, Italy. gabriele.piffaretti@tiscali.it
Tozzi
Matteo
M
Lomazzi
Chiara
C
Rivolta
Nicola
N
Riva
Francesca
F
Caronno
Roberto
R
Laganà
Domenico
D
Carrafiello
Gianpaolo
G
Castelli
Patrizio
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D002908:Chronic Disease; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007511:Ischemia / Q000628:therapy*; D008297:Male; D017538:Mesenteric Artery, Superior; D008643:Mesentery / Q000098:blood supply*; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator