Interventions for mesenteric vasculitis.
OBJECTIVE
This study reviewed the outcomes of open and endovascular revascularization for mesenteric vasculitis (MV).


METHODS
We reviewed the clinical data of all patients who underwent revascularization for occlusive MV from 1984 to 2008. Patients treated for aneurysms or mucosal bleeding without ischemic symptoms were excluded. End points were early mortality and morbidity, survival, freedom from mesenteric symptoms, and patency. Outcomes of open reconstructions were compared with the results of 163 patients who underwent open operations for atherosclerotic disease.


RESULTS
There were 15 patients (13 females, 2 males) with a mean age of 38 years (range, 15-66 years). Etiologies were Takayasu's arteritis in 7, polyarteritis nodosa in 4, indeterminate in 3, and giant cell arteritis in 1. The celiac axis was affected in 13, superior mesenteric artery (SMA) in 13, renal arteries in 8, and the aorta in 4. Seven patients had active disease, and eight were in remission. Nine (60%) presented with symptomatic chronic (n = 8) and acute (n = 1) mesenteric ischemia. Six patients with asymptomatic disease underwent mesenteric revascularization during other aortic-based operations. Fourteen patients (93%) had 10 mesenteric bypasses (8 aortic based; 2 iliac), three had aortoplasties, of which two had mesenteric patch angioplasties, and one underwent arcuate ligament release with patch angioplasty. One patient (7%) underwent percutaneous transluminal angioplasty of SMA stenosis. There were no early deaths. Early complications occurred in three patients (20%) after open reconstruction, including gastrointestinal hemorrhage, ileus with re-exploration, and superior mesenteric vein thrombosis. Median follow-up was 22 months. One graft thrombosis in a patient with active disease was treated with redo bypass 74 months after aorta-celiac-SMA bypass. All patients were alive at 10 years, with similar expected survival compared with the general population (P = .69). Compared with patients with atherosclerotic disease, open reconstructions for MV had similar freedom from mesenteric symptoms (83% vs 75%, P = .80) and similar primary graft patency (83% vs 84%, P = .9).


CONCLUSIONS
Mesenteric vasculitis is a rare manifestation of Takayasu arteritis, polyarteritis nodosa, indeterminate, or giant cell arteritis. Open revascularization is durable and effective when needed.
Rits
Yevgeniy
Y
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Oderich
Gustavo S
GS
Bower
Thomas C
TC
Miller
Dylan V
DV
Cooper
Leslie
L
Ricotta
Joseph J
JJ
Kalra
Manju
M
Gloviczki
Peter
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D001011:Aorta / Q000473:pathology; D001027:Aortography; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002445:Celiac Artery / Q000000981:diagnostic imaging; D002908:Chronic Disease; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications / Q000628:therapy; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D010488:Polyarteritis Nodosa / Q000150:complications / Q000628:therapy; D012042:Registries; D012077:Renal Artery / Q000000981:diagnostic imaging; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013625:Takayasu Arteritis / Q000150:complications / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D014657:Vasculitis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult