Technical aspects and midterm results of retrograde open mesenteric stenting for acute mesenteric ischemia

Retrograde open mesenteric stenting (ROMS) may provide satisfactory initial results for the treatment of mesenteric ischemia. However, this procedure remains technically demanding and its complications may lead to significantly higher morbidity, mortality, and reinterventions rates in severely ill patients. This study aimed to report stent-related complications and midterm outcomes of ROMS for acute mesenteric ischemia (AMI).

Clinical data and outcomes of all consecutive patients treated with ROMS for AMI between February 2014 and December 2021 at three university hospitals were reviewed retrospectively. End points included technical success, in-hospital mortality, postoperative complications, stent-related complications, and reinterventions. Three-year overall survival, freedom from reintervention, primary patency, and assisted primary patency rates were analyzed using the Kaplan-Meier time-to-event method.

Sixty-five patients presenting with AMI were included, of which 27 (40.5%) had a history of chronic mesenteric ischemia. All patients presented with mesenteric artery occlusive disease, involving the superior mesenteric artery (in situ thrombosis, n = 46; >70% stenosis, n =19). Overall technical success rate of the ROMS procedure in the cohort was 88%. The overall intestinal resection rate in the cohort was 35.4% (n = 23 patients). In-hospital mortality rate was 31.2%. Stent-related complications at 30 days were reported in 26.3% of patients, including ROMS occlusion (n = 7), residual superior mesenteric artery lesion (dissection/thrombus, n = 4), distal stent kinking (n = 2), and stent migration (n = 2). The mean follow-up duration was 24.9 months. The estimated 3-year overall survival rate for the cohort was 59.7% (95% confidence interval [CI], 46.7%-70.5%). Eight patients required additional stent-related reinterventions during follow-up, giving an estimate of freedom from stent-related reintervention at three years of 68.2% (95% CI, 50%-81%). The estimated three-year primary patency and assisted primary patency rates were 81.3% (95% CI, 65.4%-90.4%) and 87.6% (95% CI, 72.3%-94.7%), respectively.

ROMS provides acceptable technical success rate and midterm outcomes but is associated with high mortality, bowel resection, and specific stent-related complication rates. Such complications, resulting in frequent reinterventions and additional mortality, could be mitigated by implementing specific technical tips.