Percutaneous transluminal angioplasty and stenting as first-choice treatment in patients with chronic mesenteric ischemia
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Published on: May 14, 2013
Bram Fioole1, Hendrik J M van de Rest, Joost R M Meijer
1Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, The Netherlands. bfioole@planet.nl
Insights
Endovascular revascularization for chronic mesenteric ischemia (CMI) shows high initial technical success (>90%). While 2-year patency is 60%, repeat endovascular treatment is effective for restenosis, with 14% requiring open surgery.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Open revascularization is the traditional gold standard for chronic mesenteric ischemia (CMI).
- Endovascular revascularization, specifically percutaneous transluminal angioplasty and stenting (PTAS), is typically reserved for patients unsuitable for open procedures.
- This study investigates PTAS as a primary treatment for CMI.
Purpose of the Study:
- To evaluate the technical and clinical success rates of endovascular revascularization as a first-choice treatment for CMI.
- To report outcomes in a series of 51 consecutive CMI patients treated at a single tertiary vascular referral center.
Main Methods:
- Retrospective review of 51 consecutive symptomatic patients with atherosclerotic CMI undergoing PTAS between July 2001 and July 2008.
- Patency assessed by computed tomography angiography (CTA); Kaplan-Meier curves used for analysis.
- Inclusion criteria focused on symptomatic patients with atherosclerotic CMI.
Main Results:
- Sixty mesenteric arteries were treated with a 93% initial technical success rate.
- Major morbidity was 4%, with no 30-day mortality observed.
- Complete symptom relief in 78% of patients; 1- and 2-year primary patency rates were 86% and 60%, respectively. 14% required open revascularization during follow-up.
Conclusions:
- PTAS demonstrates a high initial technical success rate (>90%) as a primary treatment for CMI.
- While 2-year primary patency decreases to 60%, symptomatic restenosis can be effectively managed with repeat endovascular interventions.
- Open revascularization was necessary in 14% of patients during follow-up, highlighting the role of endovascular therapy in CMI management.
Purpose:
Open revascularization in patients with chronic mesenteric ischemia (CMI) is considered the gold standard. Percutaneous transluminal angioplasty and stenting (PTAS) is often reserved for patients not suitable for open revascularization. In our institute, endovascular revascularization is the first-choice treatment. The purpose of this study was to report the technical and clinical success rates after endovascular revascularization as the first-choice treatment in a series of 51 consecutive patients with CMI at a single tertiary vascular referral center.
Methods:
A retrospective review was performed of all consecutive patients with CMI who underwent PTAS from July 2001 to July 2008. Only symptomatic patients treated for atherosclerotic CMI were included. Patency was evaluated using computed tomography angiography (CTA). Kaplan-Meier curves were used to calculate patency rates of the treated mesenteric arteries.
Results:
Sixty mesenteric arteries (30 celiac trunks, 24 superior mesenteric, and 6 inferior mesenteric arteries) were treated in 51 patients (26 men). Major morbidity was 4%. After dissection of the superior mesenteric artery (n = 1) and brachial artery (n = 1), respectively, both patients underwent endarterectomy and patch plasty. In three arteries, the lesion could not be crossed endovascularly and they were deemed immediate intention-to-treat failures. The initial technical success rate was 93%. No 30-day mortality was observed. Median follow-up was 25 months. During follow-up, 2 patients died from intestinal ischemia. Complete symptom relief was achieved in 78% of patients. Primary 1- and 2-year patency rates were 86% +/- 5% and 60% +/- 9%, respectively; primary-assisted patency rates were 88% +/- 5% and 79% +/- 7%, respectively. During follow-up, 6 patients underwent open revascularization due to failure of PTAS.
Conclusion:
The initial technical success rate of PTAS as first-choice treatment of CMI is >90%. The 2-year primary patency rate dropped to 60%, but symptomatic in-stent stenoses could often be treated successfully with renewed endovascular techniques. Including one conversion, 14% of patients needed open revascularization during follow-up.
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