Endovascular treatment of stenotic and occluded visceral arteries for chronic mesenteric ischemia.
OBJECTIVE
Percutaneous angioplasty and stenting (PTAS) is emerging as a therapeutic option for patients with chronic mesenteric ischemia. This study evaluated patency and mortality, and their relationship between degree of vessel occlusion (stenotic or totally occluded), stent characteristics, and comorbidities in patients who were treated with PTAS of the visceral vessels for chronic mesenteric ischemia.


METHODS
A retrospective review was performed of the records of all patients who underwent PTAS of the celiac, superior mesenteric, or inferior mesenteric arteries, or both, for symptomatic chronic mesenteric ischemia between January 2001 and December 2005. Patient demographics, lesion characteristics (stenosis or occlusion), interventional details, and early and late mortality rates were recorded. Cumulative mortality and patency rates and factors associated with outcomes were determined using Kaplan-Meier method and Cox proportional hazards modeling.


RESULTS
Eighty-seven mesenteric vessels (57 superior mesenteric, 23 celiac, and 7 inferior mesenteric arteries) were treated in 65 patients (29 men and 36 women). Completely occluded vessels were treated in 18 patients (28%), and >60% stenosis was treated in 47 patients (72%). Mesenteric angina was the most common symptom (97%). For the entire series, the cumulative 1-year results were primary patency, 65% (95% confidence interval [CI], 50%-80%); primary assisted patency, 97% (95% CI, 92%-100%); secondary patency, 99% (95% CI, 96%-100%); and survival, 89% (95% CI, 80%-98%). All deaths occurred <or=60 days after treatment. The endovascular treatment of visceral artery occlusion was not associated with diminished patency or survival, irrespective of stent size or number. Patients requiring bowel resection were less likely to survive than those who did not (odds ratio [OR], 26; 95% CI, 3.5-192; P < .001). One-year primary patency was worse among patients with chronic obstructive pulmonary disease (OR, 3.2; 95% CI, 1.4-7.7; P = .009) or who had femoral access (OR, 3.0; 95% CI, 1.1-7.9; P = .015).


CONCLUSIONS
For patients with chronic mesenteric ischemia, the results of endovascular treatment of occluded mesenteric arteries are indistinguishable from those treated for stenotic vessels. Patients requiring bowel resection are less likely to survive, and those with chronic obstructive pulmonary disease or who had femoral access have higher reintervention rates.
Sarac
Timur P
TP
Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio 44195, USA. SaracT@ccf.org
Altinel
Ozcan
O
Kashyap
Vikram
V
Bena
Jams
J
Lyden
Sean
S
Sruvastava
Sunita
S
Eagleton
Matthew
M
Clair
Daniel
D
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D002445:Celiac Artery / Q000503:physiopathology; D002908:Chronic Disease; D003251:Constriction, Pathologic; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D017537:Mesenteric Artery, Inferior / Q000503:physiopathology; D017538:Mesenteric Artery, Superior / Q000503:physiopathology; D008641:Mesenteric Vascular Occlusion / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency