Chronic mesenteric ischaemia: 28-year experience  of endovascular treatment.
OBJECTIVE
To report the outcomes associated with endovascular therapy for patients with chronic mesenteric ischemia (CMI).


METHODS
A retrospective review of patients who underwent endovascular therapy for CMI between April 1981 and September 2009 at a single institution was performed. Procedural details, mesenteric arteries treated, technical and clinical success rates, outcomes per patient and per vessel were assessed.


RESULTS
In 166 patients treatment was attempted using a variety of balloon and stent platforms during the 28-year period. The technical success rate was 97% per patient and 94% per vessel. The technical success rate of stenting (99.4%) was higher than for percutaneous transluminal angioplasty (PTA; 86%; P = 0.0001). Immediate clinical improvement was seen in 146 out of 166 (88.2%). The type of guidewire or device platform, brachial vs. femoral artery access, balloon and/or stent diameters used, and stenosis vs. occlusion had no statistical impact on mortality or the primary patency of any mesenteric artery outcomes. The outcome of the superior mesenteric artery (SMA) with PTA appears to be superior to that of stenting (P = 0.014).


CONCLUSIONS
Technical success rates are improved with the use of stents; however, PTA use in the SMA seems to offer better primary patency rates.


CONCLUSIONS
• Superior mesenteric artery (SMA) stenosis is often responsible for ischaemic symptoms. • Treatment with percutaneous transluminal angioplasty (PTA) seems superior to stenting • Although technical success rates are improved with the use of stents. • Higher mortality in the elderly and those presenting with nausea/vomiting/bloody stools.
Interventional Radiology, University of Virginia, Charlottesville, VA, USA. turba@me.com
Ulku Cenk
UC
Turba
Wael E
WE
Saad
Bulent
B
Arslan
Saher S
SS
Sabri
Stacey
S
Trotter
John F
JF
Angle
Klaus D
KD
Hagspiel
John A
JA
Kern
Kenneth J
KJ
Cherry
Alan H
AH
Matsumoto
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D057510:Endovascular Procedures / Q000401:mortality*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008643:Mesentery / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D010532:Peritoneal Diseases / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D015995:Prevalence; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014768:Virginia / Q000453:epidemiology