title: Retrograde open mesenteric stenting for acute mesenteric ischemia.
abstract: OBJECTIVE
  Acute mesenteric ischemia (AMI) encompasses the sequels of end-stage untreated chronic mesenteric ischemia and acute mesenteric artery thrombosis. Percutaneous mesenteric artery stenting (PMAS) is the preferred treatment of patients with AMI but is not always feasible. Retrograde open mesenteric stenting (ROMS) is a hybrid technique that combines the advantages of open surgical and endovascular approaches. The literature on the results of this new technique is scarce. The aim of this study was to evaluate the results of ROMS in a consecutive series of patients with AMI.
  
  
  METHODS
  All patients with emergent mesenteric revascularization for AMI between January 2007 and September 2011 were entered in our prospective registry. Technical success, mortality, patency, clinical success, and complication rate at 30 days and 6 and 12 months were assessed.
  
  
  RESULTS
  Sixty-eight patients presented with AMI and 54 underwent PMAS, of which four were unsuccessful and followed by ROMS. Eleven patients were directly treated with ROMS, making a total of 15 patients (10 women and five men; median age, 66 years [interquartile range, 54-73 years]). In all patients, only the superior mesenteric artery was revascularized. In nine of the 15 patients, all three mesenteric arteries were severely stenotic or occluded. Technical success was achieved in 14 patients. At ROMS in two patients, the small bowel was severely ischemic. One of these patients needed a partial bowel resection because of irreversible transmural ischemia. At 30 days, the mortality rate was 20% and the primary patency was 92%. Ten patients underwent unplanned relaparotomy, of whom one needed resection of a large part of the small bowel. At 12 months, the mortality rate was still 20%. The primary patency was 83%. Primary assisted patency was 91%, and secondary patency was 100%. Clinical success at 30 days, 6 months, and 12 months, respectively, was 73%, 67%, and 67%.
  
  
  CONCLUSIONS
  AMI is still a devastating event. If PMAS is not feasible, ROMS is a reliable alternative and is associated with a relatively low mortality and morbidity rate.
authors.affiliation: Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Surgery, Isala Clinics, Zwolle, The Netherlands. Electronic address: j.blauw@mst.nl.
authors.forename: Juliette T M
authors.initials: JT
authors.lastname: Blauw
authors.affiliation: Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Meerwaldt
authors.affiliation: Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Brusse-Keizer
authors.affiliation: Department of Gastroenterology, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Kolkman
authors.affiliation: Department of Interventional Radiology, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Gerrits
authors.affiliation: Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Geelkerken
mesh_terms: D000368:Aged; D003251:Constriction, Pathologic; D004630:Emergencies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D017538:Mesenteric Artery, Superior / Q000503:physiopathology / Q000601:surgery*; D065666:Mesenteric Ischemia; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011859:Radiography; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D014654:Vascular Patency