Endovascular treatment of stenotic and occluded visceral arteries for chronic mesenteric ischemia
Timur P Sarac1, Ozcan Altinel, Vikram Kashyap
1Cleveland Clinic Lerner School of Medicine, Cleveland, Ohio 44195, USA. SaracT@ccf.org
Insights
Percutaneous angioplasty and stenting (PTAS) offers effective treatment for chronic mesenteric ischemia, with outcomes similar for both occluded and stenotic visceral arteries. However, patients needing bowel resection face lower survival, and those with COPD or femoral access may require more interventions.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Chronic mesenteric ischemia (CMI) is a debilitating condition affecting blood supply to the intestines.
- Percutaneous angioplasty and stenting (PTAS) is an emerging endovascular therapy for CMI.
- Evaluating outcomes based on lesion severity and patient factors is crucial for optimizing PTAS treatment.
Purpose of the Study:
- To assess the patency and mortality rates following PTAS for CMI.
- To investigate the relationship between vessel occlusion degree (stenosis vs. occlusion), stent characteristics, comorbidities, and patient outcomes.
- To determine factors influencing success and survival after endovascular treatment of visceral arteries.
Main Methods:
- Retrospective review of 65 patients undergoing PTAS for symptomatic CMI between 2001-2005.
- Analysis included demographics, lesion characteristics (stenosis/occlusion), and interventional details.
- Kaplan-Meier and Cox proportional hazards modeling were used to determine cumulative mortality and patency rates.
Main Results:
- Successful PTAS was performed on 87 mesenteric vessels in 65 patients.
- One-year primary patency was 65%, with high rates of assisted (97%) and secondary (99%) patency.
- Survival at one year was 89%; however, patients requiring bowel resection had significantly lower survival (OR 26).
- Chronic obstructive pulmonary disease and femoral access were associated with worse primary patency.
Conclusions:
- Endovascular treatment of occluded mesenteric arteries yields results comparable to stenotic vessels for CMI.
- Patient factors, particularly the need for bowel resection, significantly impact survival post-PTAS.
- Comorbidities like COPD and access site choice (femoral) may influence reintervention rates.
Purpose:
Percutaneous angioplasty and stenting (PTAS) is emerging as a therapeutic option for patients with chronic mesenteric ischemia. This study evaluated patency and mortality, and their relationship between degree of vessel occlusion (stenotic or totally occluded), stent characteristics, and comorbidities in patients who were treated with PTAS of the visceral vessels for chronic mesenteric ischemia.
Methods:
A retrospective review was performed of the records of all patients who underwent PTAS of the celiac, superior mesenteric, or inferior mesenteric arteries, or both, for symptomatic chronic mesenteric ischemia between January 2001 and December 2005. Patient demographics, lesion characteristics (stenosis or occlusion), interventional details, and early and late mortality rates were recorded. Cumulative mortality and patency rates and factors associated with outcomes were determined using Kaplan-Meier method and Cox proportional hazards modeling.
Results:
Eighty-seven mesenteric vessels (57 superior mesenteric, 23 celiac, and 7 inferior mesenteric arteries) were treated in 65 patients (29 men and 36 women). Completely occluded vessels were treated in 18 patients (28%), and >60% stenosis was treated in 47 patients (72%). Mesenteric angina was the most common symptom (97%). For the entire series, the cumulative 1-year results were primary patency, 65% (95% confidence interval [CI], 50%-80%); primary assisted patency, 97% (95% CI, 92%-100%); secondary patency, 99% (95% CI, 96%-100%); and survival, 89% (95% CI, 80%-98%). All deaths occurred
Conclusions:
For patients with chronic mesenteric ischemia, the results of endovascular treatment of occluded mesenteric arteries are indistinguishable from those treated for stenotic vessels. Patients requiring bowel resection are less likely to survive, and those with chronic obstructive pulmonary disease or who had femoral access have higher reintervention rates.
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