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Published on: September 27, 2024
Endovascular therapy for chronic mesenteric ischemia
Gabriele Piffaretti1, Matteo Tozzi, Chiara Lomazzi
1Division of Vascular Surgery, Department of Surgery, University of Insubria, Ospedale di Circolo, Viale Borri 57, 21100, Varese, Italy. gabriele.piffaretti@tiscali.it
Insights
Endovascular therapy for chronic mesenteric ischemia offers effective treatment with high initial success rates. Midterm follow-up shows durable patency and symptom relief, indicating feasibility and acceptable outcomes.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Chronic mesenteric ischemia (CMI) results from obstructive disease of the superior mesenteric artery (SMA) and celiac trunk.
- Endovascular therapy presents a minimally invasive alternative to traditional surgical interventions for CMI.
Purpose of the Study:
- To evaluate the effectiveness and durability of endovascular treatment for obstructive disease affecting the SMA and celiac trunk.
- To assess technical and clinical success rates, complication incidence, and long-term outcomes in patients with CMI.
Main Methods:
- Retrospective analysis of nine patients (15 lesions) treated for CMI.
- Data collection included technical/clinical success, complications, patency rates, and patient survival.
- Mean follow-up duration was 31 months.
Main Results:
- 100% primary technical and clinical success with no perioperative mortality.
- Two patients experienced major complications (pseudoaneurysms).
- Midterm patency rate was 78% at 2 and 5 years, with survival estimates of 85% and 68%, respectively. All patients reported symptom relief.
Conclusions:
- Endovascular treatment is a feasible option for chronic mesenteric arterial obstructive disease.
- The procedure demonstrates a low complication rate and acceptable midterm results.
- Sustained clinical benefit and patency support endovascular therapy for CMI.
Purpose:
The purpose of this article is to report on the effectiveness and durability of endovascular therapy for obstructive disease of the superior mesenteric artery and celiac trunk.
Patients And Methods:
Our retrospective study population included nine patients (five women, four men; mean age 64 years, range 34-83 years) with 15 lesions. The indication for endovascular therapy was chronic mesenteric ischemia. The technical and clinical success rates and the incidence of complications were determined. Follow-up parameters included maintained patency and sustained clinical benefit.
Results:
Ten vessels were treated. The primary technical and clinical success rates were both 100% with no perioperative mortality. Major complications occurred in two patients (pseudoaneurysms). During a mean follow-up of 31 +/- 18 months (range 3-60 months), thrombosis occurred in two patients at 1 and 3 months after the procedures, respectively. Thrombosis was successfully treated by catheter-directed intraarterial thrombolysis followed by percutaneous transluminal angioplasty (PTA) (n = 1) or stenting (n = 1). At 2 and 5 years, the primary patency rate was 78%, whereas survival was estimated to be 85% and 68% at 2 and 5 years, respectively. At this follow-up, all patients had obtained relief of symptoms.
Conclusions:
Our experience suggests that endovascular treatment for chronic mesenteric arterial obstructive disease is feasible, with a low incidence of complications and acceptable midterm results.
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