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Published on: January 18, 2018
Chronic mesenteric ischaemia: 28-year experience of endovascular treatment
Ulku Cenk Turba1, Wael E Saad, Bulent Arslan
1Interventional Radiology, University of Virginia, Charlottesville, VA, USA. turba@me.com
Objective:
To report the outcomes associated with endovascular therapy for patients with chronic mesenteric ischemia (CMI).
Methods:
A retrospective review of patients who underwent endovascular therapy for CMI between April 1981 and September 2009 at a single institution was performed. Procedural details, mesenteric arteries treated, technical and clinical success rates, outcomes per patient and per vessel were assessed.
Results:
In 166 patients treatment was attempted using a variety of balloon and stent platforms during the 28-year period. The technical success rate was 97% per patient and 94% per vessel. The technical success rate of stenting (99.4%) was higher than for percutaneous transluminal angioplasty (PTA; 86%; P = 0.0001). Immediate clinical improvement was seen in 146 out of 166 (88.2%). The type of guidewire or device platform, brachial vs. femoral artery access, balloon and/or stent diameters used, and stenosis vs. occlusion had no statistical impact on mortality or the primary patency of any mesenteric artery outcomes. The outcome of the superior mesenteric artery (SMA) with PTA appears to be superior to that of stenting (P = 0.014).
Conclusion:
Technical success rates are improved with the use of stents; however, PTA use in the SMA seems to offer better primary patency rates.
Key Points:
• Superior mesenteric artery (SMA) stenosis is often responsible for ischaemic symptoms. • Treatment with percutaneous transluminal angioplasty (PTA) seems superior to stenting • Although technical success rates are improved with the use of stents. • Higher mortality in the elderly and those presenting with nausea/vomiting/bloody stools.
Insights
Endovascular therapy for chronic mesenteric ischemia (CMI) shows high technical success, especially with stenting. However, percutaneous transluminal angioplasty (PTA) may offer better long-term outcomes for the superior mesenteric artery (SMA).
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Chronic mesenteric ischemia (CMI) significantly impacts patient quality of life.
- Endovascular therapy has become a primary treatment modality for CMI.
- Understanding the long-term outcomes of different endovascular techniques is crucial.
Purpose of the Study:
- To evaluate the outcomes of endovascular therapy in patients with CMI.
- To compare the efficacy of different endovascular approaches, including stenting and percutaneous transluminal angioplasty (PTA).
- To identify factors influencing technical success and clinical outcomes in CMI treatment.
Main Methods:
- Retrospective review of 166 patients undergoing endovascular therapy for CMI from 1981 to 2009.
- Assessment of procedural details, treated mesenteric arteries, and technical/clinical success rates.
- Analysis of outcomes per patient and per vessel, comparing PTA and stenting.
Main Results:
- High technical success rates (97% per patient, 94% per vessel) were achieved.
- Stenting demonstrated a higher technical success rate (99.4%) compared to PTA (86%).
- Immediate clinical improvement was observed in 88.2% of patients, with PTA showing superior primary patency for the superior mesenteric artery (SMA).
Conclusions:
- Endovascular therapy is effective for CMI, with stenting improving technical success.
- PTA may offer better primary patency rates for the SMA compared to stenting.
- Higher mortality was noted in elderly patients and those with severe symptoms like nausea, vomiting, or bloody stools.
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