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Endovascular treatment as first choice in chronic intestinal ischemia
E Steinmetz1, E Tatou, Claire Favier-Blavoux
1Service de Chirurgie Cardio vasculaire, Hôpital du Bocage, Université de Bourgogne, Dijon, France. eric.steinmetz@chu-dijon.fr
Insights
Endovascular treatment, specifically percutaneous angioplasty, is effective for chronic intestinal ischemia (CII). Focusing on a single affected artery offers a reasonable and efficient therapeutic approach for patients with CII.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Chronic intestinal ischemia (CII) significantly impacts patient quality of life.
- Defining optimal treatment strategies for CII is crucial.
Purpose of the Study:
- To evaluate the role and efficacy of endovascular treatment in patients with symptomatic chronic intestinal ischemia.
- To assess the feasibility of percutaneous angioplasty for intestinal artery stenosis.
Main Methods:
- A retrospective analysis of 19 consecutive patients with symptomatic CII treated between 1989 and 2001.
- Patients underwent percutaneous angioplasty of stenotic intestinal arteries (SMA, CA, IMA).
- Angioplasty involved balloon dilation, with stenting used in 7 patients due to recoil or dissection.
Main Results:
- Endovascular treatment was successfully applied as an initial therapy for CII.
- 16 out of 19 patients presented with postprandial pain, and 14 experienced weight loss.
- Stenoses were predominantly in multiple arteries (17/19), with angioplasty focused on one artery per patient.
Conclusions:
- Endovascular treatment is a viable initial therapeutic option for chronic intestinal ischemia.
- Targeting a single stenotic artery with angioplasty demonstrates short- and long-term effectiveness.
- Percutaneous angioplasty offers a minimally invasive approach for managing CII.
Abstract:
The purpose of this study was to define the place of endovascular treatment in chronic intestinal ischemia (CII). We report here a series of 19 consecutive patients treated with percutaneous angioplasty of the intestinal arteries. We excluded patients with acute ischemia, from the study. From January 1, 1989 to December 31, 2001, 19 patients with symptomatic CII were treated by endovascular techniques. This study group included 11 men and 8 women with a mean age of 59 years (range 30 to 90 years). The clinical presentation included postprandial pain in 16 patients, weight loss in 14 patients, with a mean weight loss of 7.4 kg (range 0 to 30 kg); and gastroparesis in 2 patients. Stenoses were significant in the single superior mesenteric artery (SMA) in 2 patients and in two arteries in 17 patients, including the celiac artery (CA) and SMA (n = 13), CA and inferior mesenteric artery (IMA) (n = 1), and SMA and IMA (n = 3). Balloon angioplasty was performed in only one of the arteries in each patient, 15 times in the SMA and 4 times in the CA. In 7 patients, angioplasty required stenting because of recoil (n = 5) or dissection (n = 1). In one patient the lesion was stented primarily, because of adjacent thrombus on the stenosis. Our results showed that initial treatment of CII can be endovascular. Focus on one artery only, seems to be reasonable and efficient in the short and long term.