Mesenteric artery complications during angioplasty and stent placement for atherosclerotic chronic mesenteric ischemia.
OBJECTIVE
The purpose of this study was to describe the incidence, management, and outcomes of mesenteric artery complications (MACs) during angioplasty and stent placement (MAS) for chronic mesenteric ischemia (CMI).


METHODS
We retrospectively reviewed the clinical data of 156 patients treated with 173 MAS for CMI (1998-2010). MACs were defined as procedure-related mesenteric artery dissection, stent dislodgement, embolization, thrombosis, or perforation. End points were procedure-related morbidity and death.


RESULTS
There were 113 women and 43 men (mean age, 73 ± 14 years). Eleven patients (7%) developed 14 MACs, including distal mesenteric embolization in six, branch perforation in three, dissection in two, stent dislodgement in two, and stent thrombosis in one. Five patients required adjunctive endovascular procedures, including in two patients each, catheter-directed thrombolysis or aspiration, retrieval of dislodged stents, and placement of additional stents for dissection. Five patients (45%) required conversion to open repair: two required evacuation of mesenteric hematoma, two required mesenteric revascularization, and one required bowel resection. There were four early deaths (2.5%) due to mesenteric embolization or myocardial infarction in two patients each. Patients with MACs had higher rates of mortality (18% vs 1.5%) and morbidity (64% vs 19%; P <.05) and a longer hospital length of stay (6.3 ± 4.2 vs 1.6 ± 1.2 days) than those without MACs. Periprocedural use of antiplatelet therapy was associated with lower risk of distal embolization or vessel thrombosis (odds ratio, 0.2; 95% confidence interval, 0.06-0.90). Patients treated by a large-profile system had a trend toward more MACs (odds ratio, 1.8; 95% confidence interval, 0.7-26.5; P = .07).


CONCLUSIONS
MACs occurred in 7% of patients who underwent MAS for CMI and resulted in higher mortality, morbidity, and longer hospital length of stay. Use of antiplatelet therapy reduced the risk of distal embolization or vessel thrombosis. There was a trend toward more MACs in patients who underwent interventions performed with a large-profile system.
Division of Vascular and Endovascular Surgery and Department of Radiology, Mayo Clinic, Rochester, MN, USA. oderich.gustavo@mayo.edu
Gustavo S
GS
Oderich
Tiziano
T
Tallarita
Peter
P
Gloviczki
Audra A
AA
Duncan
Manju
M
Kalra
Sanjay
S
Misra
Stephen
S
Cha
Thomas C
TC
Bower
D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects* / Q000379:methods; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D002908:Chronic Disease; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D008643:Mesentery / Q000098:blood supply*; D008875:Middle Aged; D016017:Odds Ratio; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology