title: Outcome of primary percutaneous stent-revascularization in patients with atherosclerotic acute mesenteric ischemia.
abstract: Background Patients with acute mesenteric ischemia (AMI) often exhibit severe co-morbidities and significant surgical risks, leading to high perioperative morbidity. Purpose To investigate the feasibility of primary percutaneous stent-revascularization (PPSR) in atherosclerotic AMI and its impact on patients' outcome. Material and Methods Retrospective analysis of 19 consecutive patients (7 women, 12 men; median age, 69 years) with AMI caused by atherosclerotic, non-embolic stenoses/occlusions of the splanchnic arteries and PPSR. Alternative minimally invasive techniques were excluded. Clinical characteristics including the Charlson Comorbidity Index adjusted by age (CCIa) and symptom duration, technical and clinical success of PPSR, clinical course, 30-day mortality, and follow-up were evaluated and compared to literature data for surgical approaches. Technical success was defined as residual stenosis of <30% in diameter. Clinical success was defined as resolution of symptoms of AMI and/or normalization of serum lactate after sole PPSR. Results The majority of patients presented with severe co-morbidities (CCIa >4 in 17 of 19 patients, 89%). Median symptom duration was 50 h. Technical and clinical success rates of PPSR were 95% (21 of 22 arteries) and 53% (10 of 19 patients). Seven patients underwent subsequent laparotomy with bowel resection in four cases. Thirty-day mortality was 42% (8 of 19 patients). Conclusion In our study population of patients with atherosclerotic AMI, severe co-morbidities, prolonged acute symptoms, and significant perioperative risks PPSR of splanchnic stenoses were technically feasible and the clinical outcome was acceptable.
authors.affiliation: 1 Department of Neuroradiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.|2 Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Forbrig
authors.affiliation: 3 Department of Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Renner
authors.affiliation: 4 Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kasprzak
authors.affiliation: 3 Department of Surgery, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Marc-H
authors.initials: MH
authors.lastname: Dahlke
authors.affiliation: 2 Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Müller-Wille
authors.affiliation: 2 Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stroszczynski
authors.affiliation: 2 Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Heiss
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications*; D057510:Endovascular Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D065666:Mesenteric Ischemia / Q000150:complications* / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
keywords: Acute mesenteric ischemia; bowel necrosis; mortality; percutaneous endovascular intervention; stent-revascularization