title: Endovascular recanalization of total occlusions of the mesenteric and celiac arteries.
abstract: OBJECTIVE
  To evaluate our experience with the endovascular treatment of total occlusions of the mesenteric and celiac arteries.
  
  
  METHODS
  We performed a retrospective review of endovascular stenting of 27 nonembolic total occlusions of the superior mesenteric artery (SMA) and celiac artery (CA) between July 2004 and July 2011 (26 patients, 16 females; mean age, 62 ± 13 years). A variety of demographic, lesion-related and procedure-related variables were evaluated for potential impact of technical success and patency. The follow-up protocol included clinical assessment, and color and spectral Doppler evaluation of the stented vessel(s).
  
  
  RESULTS
  The clinical presentation was chronic mesenteric ischemia in 12 patients, acute mesenteric vascular syndromes in 10 patients, foregut ischemia/ischemic pancreatitis in three patients, and prior to endovascular repair of aortic aneurysm in one patient. The treated vessel was SMA in 22 procedures, CA in three, and both SMA and CA in one. Technical success was achieved in 23 of the 27 attempted recanalizations (85%). Three patients who failed the attempt underwent open bypass, and another one underwent retrograde recanalization and stenting of the SMA. Procedure success was only significantly related to patient age <70 years or procedure performance after the year 2006. Notably, the presence of a stump, ostial plaque, extensive vascular calcification, recanalization route (intraluminal vs subintimal), occlusion length, and vessel diameter had no significant impact on procedure success. Traditional duplex criteria proved unreliable in predicting restenosis. Life table analysis of freedom from symptom recurrence showed a primary and assisted rates of 58% and 80% at 1 year, and 33% and 60% at 2 years, respectively. Clinical recurrences developed in six patients (four presented with abdominal angina and weight loss, two presented with abdominal catastrophe). There were six access-related complications and no procedural deaths. Four delayed deaths occurred during follow-up (two cardiac causes, two due to abdominal sepsis).
  
  
  CONCLUSIONS
  Endovascular recanalization of mesenteric artery occlusion is both feasible and successful, provided careful planning is used.
authors.affiliation: Department of Surgery, The University of Iowa Roy and Lucille Carver College of Medicine, Iowa City, IA 52242, USA. mel-sharafuddin@uiowa.edu
authors.forename: Mel J
authors.initials: MJ
authors.lastname: Sharafuddin
authors.forename: Rachael M
authors.initials: RM
authors.lastname: Nicholson
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Kresowik
authors.forename: Parth B
authors.initials: PB
authors.lastname: Amin
authors.forename: Jamal J
authors.initials: JJ
authors.lastname: Hoballah
authors.forename: William J
authors.initials: WJ
authors.lastname: Sharp
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007484:Iowa; D007511:Ischemia / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015993:Life Tables; D008297:Male; D008638:Mesenteric Arteries; D065666:Mesenteric Ischemia; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014652:Vascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D014654:Vascular Patency