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Stenting of stenotic mesenteric arteries for symptomatic chronic mesenteric ischemia
R Aschenbach1, H Bergert, M Kerl
1Diagnostic and Interventional Radiology and Neuroradiology, Helios Hospital Erfurt, Germany. rene.aschenbach@helios-kliniken.de
Insights
Stenting is an effective first-line treatment for chronic mesenteric ischemia (CMI), successfully relieving symptoms like abdominal pain and weight loss in most patients. This endovascular approach offers a high rate of technical success and significant clinical improvement.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Gastroenterology
Background:
- Chronic mesenteric ischemia (CMI) significantly impacts patient quality of life.
- Understanding the efficacy of endovascular interventions is crucial for CMI management.
Purpose of the Study:
- To evaluate the role and outcomes of stenting in patients with CMI.
- To assess the technical success and clinical effectiveness of endovascular stent revascularization.
Main Methods:
- Retrospective review of 45 CMI patients treated with endovascular stenting (2008-2011).
- Diagnosis confirmed by clinical symptoms and advanced imaging (duplex ultrasonography, CT angiography, MRA).
- Analysis of technical success rates and clinical symptom relief post-procedure.
Main Results:
- High technical success rate of 94.8% (42/45 patients).
- Significant symptom relief: 86.6% for abdominal pain, 90.3% weight gain, and 90.9% recovery from ischemic colitis.
- Stenting was performed on SMA, celiac artery, and IMA, individually or in combination.
Conclusions:
- Stent revascularization is a viable first-line therapy for CMI.
- Endovascular stenting provides effective symptom management and improves outcomes for CMI patients.
Background:
We report the results of our single center series of patients with chronic mesenteric ischemia (CMI) to determine the role of stenting in the management of patients.
Patients And Methods:
We retrospectively reviewed all patients with CMI treated endovascularly with stent revascularisation from January 2008 to January 2011.CMI diagnosis was made according to clinical symptoms, including postprandial abdominal pain, food fear, and weight loss. Additionally, the diagnosis was confirmed by duplex ultrasonography and/or computed tomography angiography and/or contrast-enhanced magnetic resonance angiography.
Results:
All 45 patients presented with typical CMI symptoms: 45/45 (100 %) had postprandial pain, 31/45 (68.8 %) had a weight loss of more than 10 kilograms, and 11/45 (24.4 %) suffered from ischemic colitis combined with lower gastrointestinal bleeding. In three patients occlusion could not be crossed, therefore considered as technical failure. A total of 55 arteries were stented in the remaining 42 patients. Nineteen patients underwent SMA stenting alone, eight underwent celiac stenting, alone and three patients underwent stenting of inferior mesenteric artery (IMA) alone. We performed combined stenting of the celiac artery and superior mesenteric artery in ten patients, and one patient underwent a combined stenting of the celiac artery and the IMA. All three mesenteric arteries were stented in only one patient. Primary technical success was achieved in 42/45 (94.8 %) patients. Clinical symptom relief was achieved in 39/45 (86.6 %) patients with abdominal pain. Increased body weight was observed in 28/31 (90.3 %) patients with an average weight gain of 8.8 kilograms (5 - 12 kilograms), and 10/11 (90.9 %) patients recovered from ischaemic colitis/lower gastrointestinal bleeding.
Conclusions:
Stent revascularisation can be considered as the first-line therapy for patients with chronic mesenteric ischemia.
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