Percutaneous transluminal angioplasty and stenting as first-choice treatment in patients with chronic mesenteric ischemia.
OBJECTIVE
Open revascularization in patients with chronic mesenteric ischemia (CMI) is considered the gold standard. Percutaneous transluminal angioplasty and stenting (PTAS) is often reserved for patients not suitable for open revascularization. In our institute, endovascular revascularization is the first-choice treatment. The purpose of this study was to report the technical and clinical success rates after endovascular revascularization as the first-choice treatment in a series of 51 consecutive patients with CMI at a single tertiary vascular referral center.


METHODS
A retrospective review was performed of all consecutive patients with CMI who underwent PTAS from July 2001 to July 2008. Only symptomatic patients treated for atherosclerotic CMI were included. Patency was evaluated using computed tomography angiography (CTA). Kaplan-Meier curves were used to calculate patency rates of the treated mesenteric arteries.


RESULTS
Sixty mesenteric arteries (30 celiac trunks, 24 superior mesenteric, and 6 inferior mesenteric arteries) were treated in 51 patients (26 men). Major morbidity was 4%. After dissection of the superior mesenteric artery (n = 1) and brachial artery (n = 1), respectively, both patients underwent endarterectomy and patch plasty. In three arteries, the lesion could not be crossed endovascularly and they were deemed immediate intention-to-treat failures. The initial technical success rate was 93%. No 30-day mortality was observed. Median follow-up was 25 months. During follow-up, 2 patients died from intestinal ischemia. Complete symptom relief was achieved in 78% of patients. Primary 1- and 2-year patency rates were 86% +/- 5% and 60% +/- 9%, respectively; primary-assisted patency rates were 88% +/- 5% and 79% +/- 7%, respectively. During follow-up, 6 patients underwent open revascularization due to failure of PTAS.


CONCLUSIONS
The initial technical success rate of PTAS as first-choice treatment of CMI is >90%. The 2-year primary patency rate dropped to 60%, but symptomatic in-stent stenoses could often be treated successfully with renewed endovascular techniques. Including one conversion, 14% of patients needed open revascularization during follow-up.
Fioole
Bram
B
Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. bfioole@planet.nl
van de Rest
Hendrik J M
HJ
Meijer
Joost R M
JR
van Leersum
Marc
M
van Koeverden
Sebastiaan
S
Moll
Frans L
FL
van den Berg
Jos C
JC
de Vries
Jean-Paul P M
JP
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002908:Chronic Disease; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008638:Mesenteric Arteries; D008641:Mesenteric Vascular Occlusion / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency