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Mesenteric stenting for chronic mesenteric ischemia.

David J Brown1, Marc L Schermerhorn, Richard J Powell

  • 1Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.

Journal of Vascular Surgery
|August 17, 2005
PubMed
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Mesenteric stenting offers a low-risk option for chronic mesenteric ischemia (CMI) treatment, but restenosis and recurrent symptoms necessitate close monitoring and potential reintervention. This endovascular approach shows promise for select patients.

Area of Science:

  • Vascular Surgery
  • Interventional Cardiology
  • Gastroenterology

Background:

  • Mesenteric stenting adoption for chronic mesenteric ischemia (CMI) is limited.
  • Advancements in device technology offer potential to reduce perioperative bowel necrosis.
  • This study reviews initial experiences with mesenteric stenting for CMI.

Purpose of the Study:

  • To examine the short-term outcomes of mesenteric stenting for CMI.
  • To compare mesenteric stenting outcomes with historical open surgical revascularization data.

Main Methods:

  • Retrospective analysis of patients treated with mesenteric stenting for CMI.
  • Exclusion of patients with acute mesenteric ischemia.
  • Evaluation of perioperative morbidity/mortality, restenosis, recurrent symptoms, and reintervention rates.

Related Experiment Videos

  • Kaplan-Meier analysis for follow-up events.
  • Comparison with a historical cohort undergoing open surgical revascularization.

    • Main Results:

    • No perioperative or 30-day mortality or major morbidity in 14 stented patients.
    • Early restenosis (6 months) and recurrent symptoms occurred in 10% and 9% of patients, respectively.
    • At 13 months follow-up, 53% required reintervention, yet 93% were symptom-free.
    • Stenting group had lower perioperative morbidity and shorter hospital/ICU stays than open surgery.
    • Stenting was associated with higher rates of restenosis, recurrent symptoms, and reintervention compared to open surgery.

    Conclusions:

    • Mesenteric stenting for CMI is feasible with low perioperative risk.
    • Early restenosis and recurrent symptoms are significant concerns requiring secondary procedures.
    • Patients with severe nutritional depletion or high surgical risk may benefit from stenting, necessitating close follow-up.
    • Open surgery or repeat endovascular procedures are viable options for managing restenosis.