title: Endovascular Treatment of Chronic Mesenteric Ischemia in the Setting of Occlusive Superior Mesenteric Artery Lesions.
abstract: BACKGROUND
  Endovascular intervention is considered the first-line treatment for chronic mesenteric ischemia (CMI) when feasible. Two-vessel revascularization is most definitive when celiac (CA) and superior mesenteric arteries (SMA) are diseased, but single-vessel intervention may be performed in patients with 2-vessel disease due to anatomic/technical factors. We evaluated anatomic predictors of clinical outcomes associated with endovascular treatment of CMI among patients with occlusive SMA lesions.
  
  
  METHODS
  Patients with CMI treated with endovascular revascularization over 10 years were identified. Patients with SMA occlusions were selected for analysis. Between-group comparisons based on inclusion of an SMA revascularization were evaluated using t-test and chi-squared test. Freedom from symptomatic recurrence or repeat intervention was analyzed using proportional hazards regression.
  
  
  RESULTS
  Fifty-four patients with CMI were analyzed. Sixteen (29.6%) patients had CA-only intervention, and 38 (70.4%) patients had SMA revascularization with or without CA intervention. No significant differences in demographics or comorbidity were identified between groups. In the CA-only intervention group, 8 of the 16 (50%) patients developed symptomatic recurrence compared with 8 of the 31 (21.1%) patients whose intervention included the SMA. Patients treated without SMA intervention also had decreased freedom from both symptomatic recurrence (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.2-8.6, P = 0.016) and repeat intervention (HR 5.5, 95% CI 1.8-16.3, P = 0.001).
  
  
  CONCLUSIONS
  Among patients with CMI and occlusive SMA lesions, SMA revascularization appears to be the key determinant for symptomatic outcomes and repeat intervention. Patient counseling should include potential future need for surgical revascularization if endovascular SMA treatment cannot be accomplished.
authors: Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC. Electronic address: mgoldman@wakehealth.edu.
authors: Matthew P
authors: MP
authors: Goldman
authors: Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
authors: Thomas E
authors: TE
authors: Reeve
authors: Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
authors: Timothy E
authors: TE
authors: Craven
authors: Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
authors: Matthew S
authors: MS
authors: Edwards
authors: Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
authors: Matthew A
authors: MA
authors: Corriere
authors: Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
authors: Justin B
authors: JB
authors: Hurie
authors: Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
authors: Nitin
authors: N
authors: Garg
authors: Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
authors: Gabriela
authors: G
authors: Velazquez-Ramirez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D012008:Recurrence; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency