Endovascular therapy of chronic mesenteric ischaemia.
BACKGROUND
Chronic mesenteric ischaemia (CMI) is associated with a high morbidity and mortality. Most likely causes of CMI are atherosclerosis, external compression (Dunbar Syndrome) and vasculitis. We report on our experience with endovascular stent therapy.


METHODS
Between Sept. 1998 and Dec. 2005 we treated 21 consecutive patients (52% male; mean age 64+/-15 years, range 18-81 years) due to symptomatic CMI. A total of 34 interventions with 41 treated lesions were performed. Aetiology of vessel obstruction was atherosclerosis in 14 patients (67%), Dunbar syndrome in 3 patients (14%), chronic type B aortic dissection in 2 patients (9%), Takayasu's arteritis in 1 patient (4.5%), external compression following abdominal surgery in 1 patient (4.5%). Target lesions were celiac trunk (n=16), superior mesenteric artery (n=24), and inferior mesenteric artery (n=1). Twenty-two percent (n=9) of the lesions were total occlusions. The patients underwent serial follow-up duplex examinations before discharge and every 6 months thereafter or in case of symptom recurrence.


RESULTS
Thirty-one of the 34 (91%) interventions were technically successful (37/41 lesions; 90%). Two of these 4 lesions were treated successfully using another approach in a second intervention. Brachial access was used in 16/34 cases (47%). One or more stents were placed in 29/34 interventions (85%) and 35/41 lesions. In 3 cases, in-stent restenosis was treated with balloon angioplasty alone, and in two cases, 3 occlusions could not be reopened. During 6 interventions, drug eluting stents were placed. All patients treated successfully were free of symptoms immediately after the intervention with recurrence of symptoms in case of restenosis. After a mean follow-up of 31+/-26 (range 0-87) months restenosis was detected in 6 patients (29%). Two major complications occurred which were treated without permanent sequelae.


CONCLUSIONS
Stenoses of mesenteric arteries resulting in symptomatic CMI can be treated successfully with stent-angioplasty; for anatomical reasons, the brachial approach should be considered. Recanalisation of total obstructions is feasible if a stump of the occluded artery is detectable. Restenosis is frequent and can easily be treated with balloon angioplasty or stent-in-stent placement.
Zeller
Thomas
T
Department Angiology, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
Rastan
Aljoscha
A
Schwarzwälder
Uwe
U
Schwarz
Thomas
T
Frank
Ulrich
U
Bürgelin
Karlheinz
K
Sixt
Sebastian
S
Müller
Christian
C
Rothenpieler
Uwe
U
Flügel
Peter-Christian
PC
Neumann
Franz-Josef
FJ