Symptom relief in patients undergoing endovascular management of chronic mesenteric ischemia

Chronic mesenteric ischemia (CMI) is a rare, but potentially fatal condition, which is becoming increasingly prevalent in elderly patients. This study investigated the impact of endovascular intervention on patient symptomology and the influence of extent of mesenteric disease on patient morbidity and mortality.

All patients who underwent primary angioplasty (±stenting) to the mesenteric vessels for CMI between July 2008 to July 2017 were retrospectively identified. Patient data relating to comorbidities, clinical presentation, disease burden, procedural details, symptomatology, reintervention and mortality were collected. Mortality was assessed using regression analysis, which was adjusted for age and gender.

Overall, 38 patients were included in the study. The median age was 73.5 years (interquartile range, 70.0-77.8). Abdominal pain (N.=36), postprandial pain (N.=32) and weight loss (N.=32) were the most common symptoms reported at presentation. Technical success was achieved in 37 patients. Thirty-two patients were symptom free at 6 weeks and 29 patients were symptom free at 2 years. Overall 5 patients required reintervention. At 30 days and 2 years one and seven patients were deceased, respectively. Significant association was observed between three vessel intervention and overall mortality (adjusted odds ratio 14.5, 95% confidence interval: 1.28-165.86, P=0.031). Majority of patients died of a cause unrelated to their CMI.

Endovascular intervention for CMI is safe and provides satisfactory short-term and intermediate term symptom resolution in majority of patients. This study supports the routine use of endovascular intervention in the management of this complex disease.