title: Management of chronic mesenteric vascular insufficiency: an endovascular approach.
abstract: BACKGROUND
  In patients with chronic mesenteric insufficiency (CMI), traditional bypass surgery carries a high operative mortality. Endovascular therapy for reconstruction of the mesenteric vascular system has high technical success but poor long-term patency. Secondary procedures are often mandatory for recurrent disease. The purpose of this study was to evaluate an endovascular-first treatment strategy for CMI, reserving open reconstruction for complex disease patterns without an endovascular option.
  
  
  METHODS
  Data for consecutive adult patients (N = 107) initially treated with endovascular techniques for CMI were reviewed. The management algorithm consisted of postoperative and biannual ultrasound and clinical follow-up.
  
  
  RESULTS
  A total of 107 patients with CMI were treated from April 2004 through June 2010. Technical success for endovascular reconstruction was 100%. Long-term follow-up data were available on 90% of patients. After the index procedure, 57% of patients (n = 55) had complete resolution of the preoperative symptoms. During the management phase, 83% of patients had elevated velocities on duplex evaluation. During this interval, 53% of patients required no further intervention after the index procedure, and the remaining patients required an additional 78 procedures. Five patients required open revascularization for recurrent disease, and only 2 patients died from complications of mesenteric insufficiency.
  
  
  CONCLUSIONS
  Endovascular management for CMI has a high technical success rate with low morbidity and mortality. Regular follow-up is essential to optimize patient outcomes. Ultrasound findings alone are a poor predictor of recurrent disease. Long-term success requires adaptation of a management program to elicit recurrent symptoms and offer prompt treatment.
authors.affiliation: Department of Surgery, University of Tennessee College of Medicine, Chattanooga Unit, Chattanooga, Tennessee, USA.
authors.forename: Denny M
authors.initials: DM
authors.lastname: Schoch
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: LeSar
authors.forename: Charles S
authors.initials: CS
authors.lastname: Joels
authors.forename: Luke S
authors.initials: LS
authors.lastname: Erdoes
authors.forename: L Richard
authors.initials: LR
authors.lastname: Sprouse
authors.forename: Mark W
authors.initials: MW
authors.lastname: Fugate
authors.forename: Michael S
authors.initials: MS
authors.lastname: Greer
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Fisher
authors.forename: Heather
authors.initials: H
authors.lastname: Mixon
authors.forename: Michael
authors.initials: M
authors.lastname: Hogan
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Burns
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D002908:Chronic Disease; D015331:Cohort Studies; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D008297:Male; D065666:Mesenteric Ischemia; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery